Addressing unprofessional behaviors in the clinical learning environment: lessons from a multi-year virtual, intergenerational, interdisciplinary workshop

INTRODUCTION

Optimizing the clinical learning environment (CLE) is a medical education priority nationwide.

MATERIALS AND METHODS

We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions.

RESULTS

Over two sessions (2021-2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants' ability to recognize and respond to challenges in the CLE.

DISCUSSION

Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants' knowledge and commitment to improve the CLE.

Emotional intelligence as a predictor of conflict management styles among dental hygiene students

INTRODUCTION

In dental hygiene education, a combination of ethics and professionalism, critical thinking, and problem-solving skills are utilized while managing conflict in academic settings, especially in academic clinical patient care settings. Limited evidence exists in determining whether emotional intelligence is related to conflict management styles (CMS).

PURPOSE

The purpose of this study was to determine whether relationships exist between emotional intelligence and CMS among undergraduate dental hygiene students.

METHODS

This quantitative cross-sectional survey research study involved a non-probabilistic sample of undergraduate dental hygiene students in the Western United States. The survey instrument consisted of three parts: 1. The Rahim Organizational Conflict Inventory-II (ROCI-II) included 28 questions measuring 5 CMS; 2. The Emotional Quotient Self-Assessment Checklist (EQSAC) included 30 questions measuring 6 domains of emotional intelligence (EI); and 3. Demographic questions. The data were analysed using descriptive statistics, correlational statistics and multiple linear regression.

RESULTS

The responses from 92 participants were analysed. Most dental hygiene participants had EI scores in the moderate range and mainly used the collaborative and compromising CMS. Total EI scores were significant predictors of collaborative, compromising, accommodating and competing CMS.

CONCLUSION

Improving EI scores may contribute to the increased use of the collaborative and compromising CMS in dental hygiene education.

The positive and negative consequences of stress and its relationship with coping in medical students: A qualitative study

Rates of mental health problems among medical students have prompted efforts to reduce stress during medical training. However, stress can be motivating and is a feature of clinical work. This qualitative study explores what makes an experience stressful, and how medical students respond to such experiences. In-depth interviews were conducted with a purposive sample of 15 medical students. Experiences were distressing when they threatened students' self-perception, goals or coping mechanisms, or when they reminded the student of distressing past events. Moderate stress was motivating and could build resilience. Students selected coping mechanisms based on their availability, acceptability, likely outcome and their previous experience of using these mechanisms. Social support, extra-curricular activities and exercise were helpful. High levels of distress, poor self-esteem and course factors, including remote placements, impaired engagement with coping strategies. Perception of stressors as being insurmountable or beyond one's control, led to increasing distress and the adoption of avoidant coping strategies. University strategies need to consider the beneficial effects of stress and seek to bolster coping resources as well as minimising unnecessary sources of stress.

Concordance of judgement: A tool to foster the development of professionalism in dentistry

INTRODUCTION

Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion.

MATERIALS AND METHODS

After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience.

RESULTS

The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance.

CONCLUSION

The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum.

Improving undergraduate students' email etiquette with computer-based instruction

Email etiquette is an important skill, especially in professional settings. Research demonstrates that undergraduate students follow email rules when given written instructions plus an example. The purpose of the present study was to evaluate the effects of computer-based email instruction on undergraduate students' email etiquette and to assess the social validity of that instruction. The email instruction package was delivered through an online learning management system and consisted of written instructions plus a model, a quiz, and quiz feedback. We measured email etiquette by scoring emails from course assignments using a checklist. The instruction package produced a replicated increase in mean email checklist scores across two sections of introductory psychology, and checklist scores were elevated when participants sent emails in a novel context. The results of the social-validity assessments suggest that the goals were important, the procedures were acceptable, and there were meaningful improvements in email etiquette for some participants.

Pharmaceutical industry-sponsored meals are associated with increased prescriptions and Medicare spending for dupilumab among dermatologists in the United States

RATIONALE

Healthcare industry sometimes make large marketing payments to physicians. Previous studies have demonstrated that there are significant associations between industry marketing practices and physicians' prescribing behaviours in several specialties. Given the current increasing introduction of many novel biologics for atopic dermatitis and increasing payments to dermatologists, the industry payments to dermatologists for atopic dermatitis drugs could be associated with their prescribing patterns in the United States.

AIMS AND OBJECTIVES

This study aims to evaluate association between dermatologists' dupilumab prescription behaviours and manufacturer's sponsored meal payments to dermatologists in the United States.

METHOD

Using the Centers for Medicare and Medicaid Services and the Open Payments Database, this cross-sectional analysis evaluated associations between manufacturer's sponsored meal payments to dermatologists related to dupilumab and dermatologists' dupilumab prescriptions between 2017 and 2021. Associations were evaluated using logistic generalised estimating equations (GEE) and negative binomial regression GEE models at individual dermatologist level.

RESULTS

Among 2852 dermatologists prescribing dupilumab, 74.5% received meal payments amounting to $1,083,919 between 2017 and 2021. Dermatologists receiving meal payments were more likely to prescribe dupilumab (odds ratio 1.50, 95% confidence interval [CI]: 1.37-1.65). There were also consistent dose-response associations between meal payments and total claims as well as Medicare spending. Dermatologists who received 1, 2-5, 6-10, and 11-15 meal payments per year reported 1.13 (95% CI: 1.03-1.24, p < 0.05), 1.35 (95% CI: 1.24-1.46, p < 0.001), 1.64 (95% CI: 1.48-1.82, p < 0.001), and 2.10 (95% CI: 1.78-2.47, p < 0.001) times more dupilumab-related claims in the year when they received the payments than those who did not receive the payments, respectively.

CONCLUSION

This study found that significant associations between industry-sponsored meal payments and increased dupilumab prescriptions, shedding light on the potential influence of financial relationships on clinical practice. The findings call for heightened awareness among dermatologists, patients, and policymakers regarding the impact of these relationships on healthcare expenditures and decision-making in the United States. Future research is warranted to further explore these associations longitudinally.

Clinician responses to disruptive intraoperative behaviour: patterns and norms identified from a multinational survey

PURPOSE

Disruptive intraoperative behaviour can have detrimental consequences for clinicians, institutions, and patients. The way victims and witnesses respond to disruptive behaviour can ameliorate or exacerbate consequences. Nevertheless, previous research has neither described the responses of a multinational sample of clinicians nor developed tools to recognize and evaluate responses.

METHODS

After obtaining ethics committee approval, 23 perioperative organizations distributed a survey evaluating clinician responses to disruptive behaviour. We grouped responses into four response strategies: passive, assertive, manipulative, and malicious. Thereafter, we derived norms (i.e., percentile distributions) for each response strategy using empirical distribution functions. Latent profile analysis identified groups of clinicians balancing their use of the four response strategies differently (i.e., response pattern groups). We used Chi square tests to examine associations between response pattern groups and respondent demographics.

RESULTS

We analyzed 4,789 complete responses. In response to disruptive behaviour, 33.7% of clinicians altered medical care in ways that were unindicated, 54.6% avoided communication with team members, and 12.1% misled the offender. Profile analysis identified five response pattern groups: extreme passive-predominant (30.5% of clinicians), extreme assertive-predominant (20.5%), moderate passive-predominant (18.9%), moderate assertive-predominant (26.5%), and a disparate pattern (greater use of manipulative and malicious responses) (3.5%). Profession, sex, management responsibilities, and sexual orientation predicted the response pattern group (all, P < 0.001).

DISCUSSION

The responses of thousands of clinicians involved passivity, manipulativeness, or maliciousness. We present norms and a response pattern classification to help organizations evaluate responses, recognize response patterns, and provide tailored support to victims and witnesses.

Effects of a Problem-Based Learning Education Program for Occupational Health Nursing Using Smart Learning on Occupational Health Knowledge and Nursing Professionalism

This study aimed to develop a problem-based learning program for occupational health nursing using smart learning, and to report the program's effects on occupational health knowledge and nursing professionalism. A quasi-experimental study was performed using a non-equivalent control group pre-test-post-test design. An occupational health nursing problem-based learning program using smart learning was developed, and students produced videos containing problem-solving strategies in groups. The experimental and control groups consisted of 34 and 29 participants, respectively. To collect data, an online survey was conducted before and immediately after the intervention. The experimental and control group's mean scores for occupational health knowledge before the intervention were 5.74 and 7.41, respectively. Additionally, the mean scores for nursing professionalism were 3.45 and 3.66. After the intervention, both the knowledge on occupational health and nursing professionalism score improved to 8.26 and 3.64 in the experimental group. This study reported significant improvements after conducting the occupational health nursing education program. These results demonstrate the need to develop a nursing education program for problem-based learning utilizing smart learning. Moreover, filming videos in cooperation with students can improve the effectiveness of education by improving knowledge.

The role of social media in the professional sphere of Finnish registered dietitians

BACKGROUND

With the widespread use of social media, understanding how healthcare professionals, such as dietitians, utilise these platforms for their work has gained interest. The aim of the current study was to describe how Finnish registered dietitians utilise various social media channels for professional purposes. The study also investigated the perceived social media skills of dietitians.

METHODS

A cross-sectional study was conducted using an online survey administered between December 2022 and February 2023. The participants were 107 Finnish registered dietitians who held a master's degree suitable for the profession. The Fisher's exact test was employed for categorical variables, whereas the Kruskal-Wallis test was used for ordinal variables with multiple groups.

RESULTS

Out of the 107 participants, 62 (58%) reported using social media for professional purposes. The primary purposes across various social media channels were interaction with colleagues (80%) on Facebook, networking with professionals from other fields (86%) on LinkedIn and general monitoring of the field on Instagram (91%), Twitter (77%) and YouTube (58%). Dietitians' perceived social media skills were found to have a statistically significant relationship with age (p < 0.05) for all channels, except Twitter.

CONCLUSIONS

The findings suggest that Finnish dietitians predominantly utilise social media for passive monitoring of the field, rather than actively sharing content with the public. Professional communication tends to take place within their own professional groups. Incorporating social media use into the official job description could serve as an encouraging factor to enhance the professional utilisation of social media among dietitians.

Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study

BACKGROUND

Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

OBJECTIVE

We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.

METHODS

A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction.

RESULTS

The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

CONCLUSIONS

The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

Bioethics: No Method-No Discipline?

This article raises the question of whether bioethics qualifies as a discipline. According to a standard definition of discipline as "a field of study following specific and well-established methodological rules" bioethics is not a specific discipline as there are no explicit "well-established methodological rules." The article investigates whether the methodological rules can be implicit, and whether bioethics can follow specific methodological rules within subdisciplines or for specific tasks. As this does not appear to be the case, the article examines whether bioethics' adherence to specific quality criteria (instead of methodological rules) or pursuing of a common goal can make it qualify as a discipline. Unfortunately, the result is negative. Then, the article scrutinizes whether referring to bioethics institutions and professional qualifications can ascertain bioethics as a discipline. However, this makes the definition of bioethics circular. The article ends by admitting that bioethics can qualify as a discipline according to broader definitions of discipline, for example, as an "area of knowledge, research and education." However, this would reduce bioethics' potential for demarcation and identity-building. Thus, to consolidate the discipline of bioethics and increase its impact, we should explicate and elaborate on its methodology.

Is insufficient introspection a reason to terminate residency training? - Scrutinising introspection among residents who disputed dismissal

INTRODUCTION

Insufficient introspection as part of the 4I's model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals.

METHODS

We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed 'insufficient' regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection.

RESULTS

Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents' insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training.

CONCLUSIONS

Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I's model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents' introspection, but further research is needed for effective implementation in medical education.

Academic Output of Fellows of the American Association for Respiratory Care

BACKGROUND

Research is critical for the advancement of respiratory care. Fellows of the American Association for Respiratory Care (FAARCs) are nominated based on their significant contributions to the respiratory care profession. Research output is potentially an important component of qualification for FAARC. The purpose of this study is to report the academic output of respiratory therapist (RT) FAARCs.

METHODS

We identified FAARCs from the AARC web site. Research output was assessed by searching the Scopus and PubMed databases. We collected total research documents, citations, h-index, co-authors, and document type. We compared those with only the FAARC designation with RTs who are fellows in both the Society of Critical Care Medicine (FCCMs) and FAARC.

RESULTS

We identified a total of 371 RT FAARCs, 4 RT FCCMs, and 10 with both designations. FAARCs were 70% male, 22% had a doctorate, 37% had a master's, 13% had a bachelor's, and 29% did not have a degree reported. There were no differences in sex or highest degree between FAARCs and FCCMs. FAARCs had a total of 3,724 publications and 110,207 citations while those with both designations had 1,304 publications and 43,181 citations. In Scopus, 46% of FAARCs had no publications, and 27% had ≥ 10 publications; of those with both credentials, 10% had no publications, and 70% had ≥ 10 publications. FAARCs inducted in 1998 and 1999 had significantly (P < .001) more publications than other eras. Compared to those with both credentials, FAARCs had fewer median publications (1 vs 50), lower h-index (1 vs 18), and fewer citations (1 vs 1,486), P < .001 for all. Total publications in PubMed were lower, and differences in publications were similar.

CONCLUSIONS

RT FAARCs had a large number of publications and citations, although nearly half did not have any publications. Those with both FAARC and FCCM had significantly more academic output per fellow, although there are only 10 individuals with both credentials.

The role of cultural competency training to address health disparities in surgical settings

BACKGROUND

Disparities in health care delivered to marginalized groups are unjust and result in poor health outcomes that increase the cost of care for everyone. These disparities are largely avoidable and health care providers, have been targeted with education and specialised training to address these disparities.

SOURCES OF DATA

In this manuscript we have sought out both peer-reviewed material on Pubmed, as well as policy statements on the potential role of cultural competency training (CCT) for providers in the surgical care setting. The goal of undertaking this work was to determine whether there is evidence that these endeavours are effective at reducing disparities.

AREAS OF AGREEMENT

The unjustness of health care disparities is universally accepted.

AREAS OF CONTROVERSY

Whether the outcome of CCT justifies the cost has not been effectively answered.

GROWING POINTS

These include the structure/content of the CCT and whether the training should be delivered to teams in the surgical setting.

AREAS TIMELY FOR DEVELOPING RESEARCH

Because health outcomes are affected by many different inputs, should the effectiveness of CCT be improvement in health outcomes or should we use a proxy or a surrogate of health outcomes.

Synergy between formal and informal education

The informal components of education can shape a person's capacity to contribute. Such informal components might include cultural backgrounds, work experiences, and extracurricular pursuits. To appreciate the synergy between formal and informal education it can be helpful to explore a particular case of someone who actually combined the two to make the whole more than the sum of its parts.

Obstetric violence is a misnomer

The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.

Professionalism in the context of providing elective services: reflecting on bias

We examine the provision of elective pronunciation services, such as intelligibility enhancement, to non-native speakers by speech language pathologists (SLPs). Practices associated with the 'modification' of non-native accent raise significant professionalism questions about bias for SLPs and healthcare professionals. These questions arise partly due to the socio-cultural context in which SLPs practice and their clients live, and the relational nature of communication. We argue that due to the ambiguity inherent in accent modification practices, SLPs must weigh a variety of considerations before determining the circumstances in which such services are professionally acceptable. Our argument is rooted in consideration of the complex nature of professionalism related to communication. After surveying potentially relevant models from other healthcare professions and finding them wanting, we support our position in light of current literature on topics such as accounts of functionality. We conclude by generalizing our anti-bias recommendations to interprofessional healthcare professionalism.

"Definitely a Dark Time:" professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic

BACKGROUND

Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers.

OBJECTIVE

The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic.

METHODS

A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis.

RESULTS

Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time.

CONCLUSIONS

Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.

Negative faculty role modelling - is it a reflection of deteriorating societal values?

BACKGROUND

Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan.

METHODS

This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category.

RESULTS

Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels.

CONCLUSIONS

In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.

Integrating community service-learning into a dental hygiene curriculum: a document analysis

Background

Community service-learning (CSL) aims to promote civic engagement among students and deepen their understanding of social issues, connecting students to communities where they may practise as future health care providers. This study's aims were two-fold: first, to determine whether incorporating a non-dental community service-learning experience into a fourth-year behavioural science course can develop abilities related to the dental hygiene baccalaureate competencies; second, to examine the overall student learning experience.

Methods

Seven community agencies presented projects to the dental hygiene class, and students individually selected their top 3 choices. Projects were diverse, ranging from literacy tutoring to creating a program plan or hosting a public virtual event with an interprofessional health panel discussing nutrition. Dental hygiene students participated in a 20-hour placement with one community project and completed individual reflection journals that focused on their experience. Using a document analysis approach, the authors examined the reflection journals through an iterative process to identify themes.

Results

Ten student reflections were analysed and three themes emerged: 1) increased social awareness; 2) application of dental hygiene core competencies; and 3) the challenges of the learning experience. Students consistently discussed how the project allowed them to apply 5 dental hygiene core competencies and how their learning experience aligned with their future professional role as a dental hygienist. Students articulated increased understanding of their individual privilege and awareness of social issues in their community.

Conclusions

Participation in non-dental CSL increased dental hygiene students' social awareness of local communities. Students demonstrated an ability to apply their learning to their developing competencies as future dental hygienists.

Exploring Medical Students' Perceptions of Peer-to-Peer Interactions Related to Applying to a Surgical Residency

OBJECTIVE

The objectives were to (1) identify themes related to competitive peer-to-peer interactions elicited from the lived experiences of undergraduate medical students, and (2) understand how these experiences influenced medical students' choices related to surgical residency programs.

DESIGN

A qualitative descriptive methodology, with purposive and maximal variation sampling (e.g., selection based on medical school location; gender), was adopted for this study.

SETTING

Temerty Faculty of Medicine, University of Toronto.

PARTICIPANTS

Participants were 15 undergraduate medical students from 4 medical schools in Ontario, Canada, who agreed to an individual semi-structured interview by Zoom or telephone.

RESULTS

Peer-to-peer interactions influence students' perception of self and identity formation related to surgical specialty decision-making and interest. These interactions were shown to hold greater value, specifically for information gathering. Identity formation, related to pursuing a surgical residency, was influenced by the attitudes and perceptions of competition with peers throughout medical school. Cultures of competition were seen to dictate peer-to-peer interactions and their associated value, with their perception and experience differing between medical schools.

CONCLUSIONS

Peer-to-peer interactions and a culture of competition have inherent roles in the residency decision-making process. We observed that student background and pre-formed relationships influenced how students perceived and responded to competition. Addressing the culture of competitiveness associated with peer-to-peer interactions along with considering student background and pre-existing relationships may provide insight into how medical educators can tailor learning experiences that limit the detrimental effects of hidden curriculum influences.

Professionalism in pre-licensure nursing education: Core values, didactic coursework and clinical training

AIM

To discuss professionalism for pre-licensure nursing students and identify recommendations for inclusion in core values, didactic coursework and clinical training.

BACKGROUND

Professionalism is part of the nursing identity that encompasses integrity and honesty. This concept has been difficult to translate into formal education in nursing programs and clinical practice.

DESIGN

A discursive paper.

DATA SOURCES

A search of national literature without date restrictions in PubMed, CINAHL, Google Scholar and frameworks for nursing education. We explored principles of professionalism in nursing education and practice.

DISCUSSION

Evidence-based literature supports the integration of core values of altruism, autonomy, human dignity, integrity, honesty and social justice into didactic curricula, and clinical training. Principles of professionalism can be incorporated intentionally in nursing education to maintain patient safety and trust.

CONCLUSION

The principles of professionalism, related to core values of the nursing profession, are abundantly described in the literature. However, these principles represent core values that have not been formally conceptualized. With the changing landscape of healthcare, there is a need for deliberate, measurable integration of professionalism into pre-licensure education.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or drafting of this discursive paper.

The Importance of Learning with Patients: Post-Pandemic Takeaways on Learning Professionalism in Clinical Settings

Background

Public demands for high-quality healthcare require medical schools to ensure that physicians attain various competencies, including professionalism and humanism. This can be accomplished through various interactions and socialisations within the healthcare community. These meaningful learning experiences become more critical as students face unpredictable learning opportunities in clinical settings. However, professional development focuses on lapses, remediation and knowledge retention rather than its practice. To nurture professional and humanistic physicians, this study explores how medical students perceive learning professionalism in clinical settings.

Methods

This is a qualitative phenomenology study involving medical students in clinical rotations at the Faculty of Medicine Universitas Indonesia. Respondents were chosen through a purposive sampling method that considered their gender and clinical years. Data were collected through focus group discussions (FGDs) and thematic analysis was used.

Results

Three FGDs were conducted with 31 clinical students. Learning professionalism in clinical settings presents challenges, including the hidden curriculum (HC), limited exposure to patients and the clinical learning environment because of the social restrictions caused by the COVID-19 pandemic. The tailored strategy to learn professionalism in the clinical learning environment was more teacher-driven, including role modelling, debriefing, providing feedback and teaching context-specific knowledge on professionalism, followed by patient interactions.

Conclusion

The significance of students' interactions with the clinical learning environment, especially with patients and clinical teachers as role models, is the key to learning professionalism in clinical settings. This finding is an important takeaway in curriculum design for professionalism.

Which 'end' do you have in mind? Clinical supervisors' perceptions of professional Identity Formation outcomes in GP residency

PURPOSE

Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency.

METHODS

Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts.

RESULTS

We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession.

CONCLUSION

PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance.

The Australian Health Informatics Competency Framework: Conceptual Design, Framework Development, and Certification Delivery

The Australian Health Informatics Competency Framework (AHICF) guides the healthcare workforce in identifying the required competencies to perform as a health informatician, and more definitively defines the foundational body of knowledge on which the discipline is based. The aim of this paper is to describe the conceptual foundations in developing the AHICF v1.0, detail the methods used to revise and publish AHICF v2.0, and explore the certification and workforce outcomes achieved. This paper contributes to the competency framework and certification discourse, and knowledge of the increasing importance and recognition of health informaticians through certification. Further, implications for workforce training and education, career advancement and recruitment strategies, are also discussed.

Assessment of Research Ethics Knowledge of Pediatricians

Objectives. To assess knowledge of ethics knowledge among child healthcare professionals. Methods. We translated the Test of Residents' Ethics Knowledge for Pediatrics (TREK-P) in Azeri and administered it to: (i) third-year medical students (n = 21), (ii) pediatrics residents (n = 24), (iii) practicing pediatricians (n = 21), and (iv) fellows (n = 9) who participated in a Fogarty International Center/National Institute of Health (Fogarty/NIH) R25 research ethics education program. The difference in the TREK-P score between the groups and the correlation between the TREK-P score and other factors were evaluated. Results. The fellows scored significantly higher than the other groups (P = .006). There was no significant difference between the other 3 groups. Within a joined group of pediatricians and fellows, previous training on ethics was the only factor that correlated with the higher TREK-P scores (P < .05). Conclusions. The higher scores in fellows support the effectiveness of postgraduate Fogarty/NIH training programs in research ethics.

Health and social care professional standards need to be updated to advance leadership and action for environmental sustainability and planetary health

BACKGROUND

Human health is inextricably linked to planetary health. The desire to nurture and protect both concurrently requires the mitigation of healthcare-associated environmental harms and global initiatives that support sustainable lifestyles. Health leadership is important to bring adequate attention and action to address planetary health challenges. Health professionals are central to this endeavour, but the will and energy of a few will not be adequate to address this urgent challenge.

STUDY

We present an appraisal of the current UK health professional standards, frameworks and curricula to identify content related to planetary health and environmental sustainability.

RESULTS

No current UK health professional standard provides statements and competencies to guide practising and trainee health professionals to focus on and advance the sustainability agenda within their clinical practice and across wider healthcare systems.

CONCLUSION

Update of health professional standards is needed to ensure that health professionals in every specialty are supported and encouraged to lead the implementation of environmentally sustainable practices within the health sector and advocate for planetary health.

How to Exercise Integrity in Medical Billing: Don't Distort Prices, Don't Free-Ride on Other Physicians

This paper proposes that billing gamesmanship occurs when physicians free-ride on the billing practices of other physicians. Gamesmanship is non-universalizable and does not exercise a competitive advantage; consequently, it distorts prices and allocates resources inefficiently. This explains why gamesmanship is wrong. This explanation differs from the recent proposal of Heath (2020. Ethical issues in physician billing under fee-for-service plans. J. Med. Philos. 45(1):86-104) that gamesmanship is wrong because of specific features of health care and of health insurance. These features are aggravating factors but do not explain gamesmanship's primary wrong-making feature, which is to cause diffuse harm not traceable to any particular patient or insurer. This conclusion has important consequences for how medical schools and professional organizations encourage integrity in billing. To avoid free-riding, physicians should ask themselves, "could all physicians bill this way?" and if not, "does the patient benefit from the distinctive service I am providing under this code?" If both answers are "no," physicians should refrain from the billing practice in question.

Can professional nursing value claims be refused? Might nursing values be accepted provisionally and tentatively?

Value-act relationships are less secure than is commonly supposed and this insecurity is leveraged to address two questions. First, can nurses refuse professional value claims (e.g., claims regarding care and compassion)? Second, even when value claims are accepted, might values be held provisionally and tentatively? These questions may seem absurd. Nurses deliver care and nursing is, we are told, a profession the members of which hold and share values. However, focusing attention on the problematic nature of professional value claims qua claims permits a more conciliatory and realistic stance to be taken towards nurses holding alternative values and value interpretations. This could prove beneficial.

A Qualitative Study on the Development of Professionalism Among Japanese Dental Students

BACKGROUND

Professionalism is believed to vary depending on factors such as era and culture. Therefore, clarifying the meaning of professionalism in each country, region, and workplace is essential. However, how professionalism is cultivated among dental students in Japanese schools has yet to be fully elucidated. Therefore, this study examined whether professionalism among Japanese dental students changes by year. This research will contribute to effective professional education.

PARTICIPANTS AND METHODS

The participants included six fourth-year dental students and nine fifth-year dental students. Semi-structured interviews were conducted from November 2018 to January 2019, and verbatim transcripts were created from the recorded data. Based on these verbatim transcripts, thematic analysis was utilized to examine and identify professionalism components for each academic year.

RESULTS

Three themes based on 14 constituent concepts were obtained for fourth-year students. Three themes based on 20 constituent concepts were obtained for fifth-year students. Fourth-year students primarily focused on technical aspects. In contrast, fifth-year students placed greater emphasis on attitude and communication skills.

CONCLUSION

From fourth-year students, who primarily focus on classroom learning and practical training, to fifth-year students who gain clinical experience, the constituent elements of professionalism became more complex. However, this study did not examine other aspects of healthcare professionalism, such as interprofessional collaboration. A comprehensive education program tailored to the clinical setting is necessary for cultivating professionalism.

Improving optometry student interpersonal skills through online patient, clinician and student evaluation and feedback

CLINICAL RELEVANCE

Interpersonal skills are crucial for successful clinician-patient interactions. To prepare future optometrists for clinical practice, pedagogical evaluation is important to support the implementation of new strategies for teaching and evaluating interpersonal skills.

BACKGROUND

Optometry students largely develop their interpersonal skills through in-person patient interactions. Telehealth is increasing, yet strategies to develop the interpersonal skills of students for teleconsulting have not been explored. This study aimed to assess the feasibility, effectiveness and perceived usefulness of an online, multisource (patients, clinicians and students) evaluation and feedback program for developing interpersonal skills.

METHODS

Via an online teleconferencing platform, optometry students (n = 40) interacted with a volunteer patient, observed by a teaching clinician. Patients and clinicians evaluated the interpersonal skills of the student in two ways: (1) qualitative written feedback, and (2) quantitative rating (Doctors' Interpersonal Skills Questionnaire). All students received written patient and clinician feedback after the session, but not their quantitative ratings. A subset of students (n = 19) completed two sessions, self-ratings, and were provided with their written feedback and an audiovisual recording from their first interaction before completing the second session. All participants were invited to complete an anonymous survey at program completion.

RESULTS

Patient and clinician overall interpersonal skills ratings were positively correlated (Spearman's r = 0.35, p = 0.03) and showed moderate agreement (Lin's concordance coefficient = 0.34). Student self-ratings did not match patient ratings (r = 0.01, p = 0.98), whereas there was moderate agreement between clinician and student ratings (Lin's concordance coefficient = 0.30). Ratings improved at the second visit (p = 0.01). Patient ratings were higher than clinicians (p = 0.01) and students (p = 0.03). All participants agreed that the program was feasible, useful and effective at fostering good interpersonal skills.

CONCLUSION

Multisource feedback about interpersonal skills contributes to improvement in student performance. Patients and clinicians can evaluate and provide useful feedback to optometry students about their interpersonal skills using online methods.

The heart of anaesthesiology: revitalising humanism in the age of technology

Technological innovation has greatly aided modern medicine, and anaesthesiology in particular, but also contributes to dehumanising influences that promote physician burnout and dissatisfaction among patients. Here we advocate for a profound reaffirmation of humanistic principles-empathy, compassion, and communication-in perioperative medicine. We propose adaptable strategies to bolster humanism in practice, such as curricular offerings, simulation training, role modelling, and recognition. As perioperative technologies continue to evolve, the threat of depersonalisation in anaesthetic care looms, making commitments to humanism a crucial precondition for healing in the communities in which we work and live.

Professionalism Program Evaluation and Its Impact on Undergraduate Medical Students

Objective The study aims to evaluate the effectiveness of a professionalism program by conducting focus group discussions (FGDs). The research focuses on understanding how the program influences the development of professionalism skills among medical students, as well as their perceptions and experiences regarding the program. The study's objectives revolve around identifying the strengths and weaknesses of the program from the perspective of the students. Methods This was a qualitative study done after obtaining approval from the Institutional Review Committee, Islamic International Medical College. Students of 4th year Bachelor of Medicine and Bachelor of Surgery (MBBS; 56 students) were selected for the study. A convenience sampling technique was used to select the participants for FGDs. Seven separate FGDs were conducted, with eight participants in each group. All the FGDs were audiotaped. Data were transcribed and translated. Data were analyzed using the thematic analysis on Atlas. Both obvious and hidden content were analyzed. Codes and themes were identified, which were then finalized with consensus. Codes were then categorized into sub-themes, and finally, themes were generated. Results Participants identified the problems associated with applying professionalism during FGDs. These challenges encompassed hefty workloads and a perceived disparity between theoretical knowledge and practical implementation. The students highlighted the importance of practical teaching methods, the cultivation of role models, the alignment of curriculum with real-world experiences, and the revision of assessment methods. This study analyzes the obstacles and potential advantages associated with professionalism education and presents significant perspectives on improving it for upcoming healthcare practitioners. Conclusion Professionalism is a crucial component, and each graduate of a medical school should be fully qualified as a professional after graduation. As we want our future doctors to be skilled at both professional qualities and diagnosis, it is crucial that medical institutions teach professionalism.

Factors Affecting Medical Residents' Decisions to Work After Call

BACKGROUND

Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions (WHRs) are intended to improve patient safety by reducing resident fatigue. Compliance with ACGME WHRs is not universal.

PURPOSE

The purpose of this study was to identify factors that influence residents' decisions to take a postcall day (PCD) off according to ACGME WHRs.

METHODS

Residents (N = 433) at one university were emailed a link to a survey in 2019. The survey included demographic details and a Discrete Choice Experiment examining influences on resident decisions to take a PCD off.

RESULTS

One hundred seventy-five residents (40.4%) responded to the survey; 113 residents (26%) completed the survey. Positive feedback from attending physicians about taking PCDs off in the past had the greatest impact on respondents' decisions to take a PCD off, increasing the probability by 27.3%, followed by chief resident comments about the resident looking tired (16.6% increase), and having never heard their attendings comment about PCDs off as either positive or negative (13.9% increase). Factors that had the largest effect on decreasing the probability of taking a PCD were negative feedback about taking PCDs off (14.3% decrease), continuity of care concerns (10.8% decrease), and whether the resident was looking forward to an assignment (7.9% decrease).

CONCLUSIONS

The most important influencer of residents' decisions to take a PCD off was related to feedback from their attending physicians, suggesting that compliance with WHRs can be improved by focusing on the residency program's safety culture.

First patient project: Engaging pathology through the donor dissection experience and its role in professionalism

The peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.

The Relationship Between On-Site Clinical Practice, Nursing Professional Value, and Nursing Clinical Self-Efficacy During COVID-19: A Cross-Sectional Study

Background

During COVID-19, nursing students experienced variations in on-site clinical practice, such as a combination of on-site and non-face-to-face clinical practice. Although on-site clinical practice is critical for increasing nurses' clinical self-efficacy and developing professional nursing values, there is a lack of knowledge that reflects the current clinical practice environment.

Aim

To examine the relationship between on-site clinical practice, nursing professional values, and nursing clinical self-efficacy during the COVID-19 pandemic.

Methods

This study is a cross-sectional correlational study design. Demographic characteristics, on-site clinical practice, nursing professional values, and nursing clinical self-efficacy were assessed using an online survey from October 3, 2022, to November 6, 2022. Data were analyzed using descriptive statistics, ANOVA, t-test, Pearson's correlation coefficient, and multiple regression.

Results

Of the 86 participants, 18 (20.9%) were male and 68 (79.1%) were female. The duration of the participants' average participation in on-site clinical practice was 39.67 days (61.04%). Nursing professional values significantly influenced clinical self-efficacy (β=0.379, p<0.001). However, on-site clinical practice was not significantly related to clinical self-efficacy (β=0.051, p=0.611). In terms of nursing clinical self-efficacy, measuring blood glucose had the highest score. On the other hand, establishing and maintaining intravenous catheters had the lowest scores.

Conclusion

Nursing students' professional values were significantly associated with nursing clinical self-efficacy; however, the extent of involvement in on-site clinical practice during the pandemic did not have a significant impact on nursing clinical self-efficacy. Given that this study focused on a single university, it is imperative to replicate this research using diverse samples in the future. In addition, there is a need to establish a range of teaching and learning approaches for clinical practice, including simulation, online learning, and the use of state-of-the-art technology for faculty-student feedback strategies, in anticipation of the need for alternative practices.

The Development and Implementation of a Model to Facilitate Self-Awareness of Professionalism for Enrolled Nurses

Within the South African context, the nursing profession comprises different nursing cadres. The enrolled nurse is considered a sub-category of nursing and therefore does not carry the title of 'professional' as in a professional nurse. The purpose of the study was to develop, describe, implement, and evaluate a model for the facilitation of self-awareness for the professionalism of enrolled nurses at a specific nursing agency in Gauteng. A theory generating, qualitative, exploratory, descriptive and contextual design was used and was conducted following Chinn and Kramer's four stages of model development. The model can benefit nursing education because it relates to an essential aspect of growth and maturity in one's career. Ultimately, the facilitation of self-awareness for professionalism can advance one's career, or the lack of self-awareness may impede one's career. Developing, describing, implementing and evaluating this model to facilitate self-awareness for the professionalism of enrolled nurses at a specific nursing agency in Gauteng provides an original contribution to the theory in nursing professionalism and ethos. This model can be utilised as a tool to facilitate self-awareness for the professionalism of enrolled nurses at a nursing agency.

A 10-year longitudinal study of dental students' emotional intelligence and the impact of COVID-19

PURPOSE/OBJECTIVES

Emotional intelligence (EI) supports the clinical and social competencies of a practicing dentist. Reuven Bar-On's EI model is an array of inter-related emotional and social competencies, skills, and behaviors, which consist of five key domains: Self-Perception, Self-Expression, Interpersonal, Decision Making, and Stress Management, and associated with the domains are 15 emotional quotient (EQ) subskills. This study measured the impact of COVID-19 on dental students' EI by comparing measures pre-COVID-19 and during COVID-19 matriculation.

METHODS

This retrospective longitudinal study measured EI with the EQ-i 2.0 for higher education. Dental students completed an EQ-i 2.0 assessment (Attempt) at the beginning of matriculation, at the mid-point, and prior to graduation. Ten groups were included, of which the first three completed matriculation prior to the pandemic and the remaining seven matriculated during timeframes intersecting at different times during the pandemic. A paired t-test dependent sample of means (p ≤ 0.05) compared EQ scores for each attempt for all groups. The study compared means for three EQ attempts with the t-test independent sample of means (p ≤ 0.05) for cohorts matriculating pre-COVID-19 and during COVID-19.

RESULTS

The pre-COVID-19 groups showed significant increases in EQ with each subsequent attempt. COVID-19-impacted groups demonstrated significant increase in Stress Tolerance and significant decreases, most notably in the domains of Interpersonal and Self-Perception, and subscales of Optimism and Happiness.

CONCLUSION(S)

COVID-19-related stressors impacted dental students' EI as multiple EI areas declined significantly. Dental educators should minimize organizational stressors and support EI during years 2 and 3 of matriculation.

Moving towards social dentistry: How do dentists perceive the Montreal-Toulouse model?

OBJECTIVES

This study aimed to understand the perspectives of dentists towards the Montreal-Toulouse model, an innovative approach that encompasses person-centredness and social dentistry. This model invites dentists to take three types of actions (understanding, decision-making, intervening) on three overlapping levels (individual, community, societal). This study aimed to understand (a) How dentists perceived the Montreal-Toulouse model as a framework for the practice of dentistry and (b) What parts of this model they were ready to adopt in their own practice.

METHODS

A qualitative descriptive study was conducted based on semi-structured interviews with a sample of dentists in the Province of Quebec, Canada. A combination of maximum variation and snowball sampling strategies was employed and 14 information-rich participants were recruited. The interviews were conducted and audio-recorded through Zoom and lasted approximately 1 h and a half. The interviews were transcribed verbatim and thematically analysed through a combination of inductive and deductive coding.

RESULTS

The participants explained they valued person-centred care and tried to put the individual level of the Montreal-Toulouse model into practice. However, they expressed little interest in the social dentistry aspects of the model. They acknowledged not knowing how to organize and conduct upstream interventions and were not comfortable with social and political activism. According to them, advocating for better health-related policies, while a noble act, 'was not their job'. They also highlighted the structural challenges that dentists face in fostering biopsychosocial approaches such as the Montreal-Toulouse model.

CONCLUSIONS

To promote the Montreal-Toulouse model and empower dentists to address social determinants of health, an educational and organizational 'paradigm shift' towards social accountability might be necessary. Such a shift requires curricular modifications and reconsidering traditional teaching approaches in dental schools. Moreover, dentistry's professional organization could facilitate dentists' upstream actions through proper resource allocation and openness to collaboration with them.

Structural equation modeling of factors associated with nursing students' professionalism during the COVID-19 pandemic

This study aimed to determine the factors associated with nursing professionalism among Korean nursing students. This cross-sectional study was carried out using a convenient sample comprising 247 students enrolled in a four-year Bachelor of Science Nursing program from September 6-27, 2021. A self-reported structured questionnaire was employed to explore the relationships among ego-resilience, self-leadership, clinical learning environment, academic satisfaction, clinical competency, and nursing professionalism by utilizing structural equation modeling. The modified model exhibited good fit indices. Learning-related factors, including clinical learning environments, academic satisfaction, and clinical competency, directly affected nursing professionalism. Self-leadership and the clinical learning environment were indirectly associated with nursing professionalism via both academic satisfaction and clinical competency. Regarding ego-resilience, it only indirectly affected nursing professionalism via academic satisfaction. Creating a student-centered learning environment may be vital to improve students' major and clinical performance, thereby boosting nursing professionalism. Furthermore, nurse educators should consider individual psychological aspects of students when designing the nursing curriculum to foster nursing professionalism. Longitudinal studies are needed to determine if our model is available to explain the development of professionalism among nursing students.

Addressing medical resident mistreatment: A resident-centred approach

INTRODUCTION

Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes.

METHOD

We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645).

RESULTS

When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach.

CONCLUSION

Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.

Assessing professionalism in mental health clinicians: development and validation of a situational judgement test

BACKGROUND

Situational judgement test (SJT) scores have been observed to predict actual workplace performance. They are commonly used to assess non-academic attributes as part of selection into many healthcare roles. However, no validated SJT yet exists for recruiting into mental health services.

AIMS

To develop and validate an SJT that can evaluate procedural knowledge of professionalism in applicants to clinical roles in mental health services.

METHOD

SJT item content was generated through interviews and focus groups with 56 professionals, patients and carers related to a large National Health Service mental health trust in England. These subject matter experts informed the content of the final items for the SJT. The SJT was completed by 73 registered nurses and 36 allied health professionals (AHPs). The primary outcome measure was supervisor ratings of professionalism and effectiveness on a relative percentile rating scale and was present for 69 of the participating nurses and AHPs. Personality assessment scores were reported as a secondary outcome.

RESULTS

SJT scores statistically significantly predicted ratings of professionalism (β = 0.31, P = 0.01) and effectiveness (β = 0.32, P = 0.01). The scores demonstrated statistically significant incremental predictive validity over the personality assessment scores for predicting supervisor ratings of professionalism (β = 0.26, P = 0.03).

CONCLUSIONS

These findings demonstrate that a carefully designed SJT can validly assess important personal attributes in clinicians working in mental health services. Such assessments are likely to represent evidence based, cost-effective tools that can support values-based recruitment to mental health service roles.

Generic professional capabilities hub: developing leadership and management skills in trainees

High quality leadership is key to delivering high standards of patient care. For many reasons, doctors in training are not currently well represented in leadership positions and struggle to access opportunities to develop these skills. As a key cohort within the medical workforce, using existing present opportunities within clinical training programmes would allow them to engage in leadership development and support them to lead on projects within their trusts and make sustainable changes within their own organisation.Within our anaesthetic department, we designed the Generic Professional Capabilities Hub (GPC hub)-a framework that aims to address some of the barriers to engagement in clinical leadership. Involvement in the GPC hub can be at three different levels, which allows for flexibility around other training needs. Currently, there are seven workstreams within the framework, with trainees being involved through symposia attendance, leading on projects linked to the hub or becoming a trainee workstream lead. We share our learning from setting up this framework, the benefits it brings to trainees and departments, initial evaluation results and our next steps which include regional roll out to four other anaesthetic departments.

Consent Policies for Pelvic Exams Under Anesthesia Performed by Medical Students: A National Assessment

Background: Medical students report low confidence in their ability to perform pelvic exams. Pelvic exams under anesthesia (EUA) are one way for students to practice the exam, but this needs to be balanced with patients' bodily autonomy through explicit disclosure and consent. This study seeks to characterize U.S. medical schools' policies regarding the consent process for students to perform pelvic EUA. Materials and Methods: Obstetrics and gynecology clerkship directors were anonymously surveyed about their medical school affiliated hospitals' (MSAH) consent policies for pelvic EUA in general and explicitly for medical students. Chi-square and Fisher's exact test were used to test for differences between categorical variables and thematic analysis was used to review qualitative responses. Results: A total of 87 clerkship directors completed the survey (44.4% response rate). Most MSAH explicitly consent patients for pelvic EUA (80.2%), and specifically for performance by medical students (79.1%). Sixty-nine respondents (79.3%) stated that performing pelvic EUA is important for medical student education. Five themes were identified from review of qualitative responses, including consent policy details, the importance of pelvic EUA, other opportunities for pelvic exam teaching, barriers to standardization, and outside guidance. Conclusions: The pelvic EUA is a necessary part of both surgical care and medical education but patient dignity must be protected too. Most MSAH have consent policies for students to perform pelvic EUA. Still, these policies need to be further strengthened and standardized across institutions to protect patients' rights while continuing to teach students the pelvic exam.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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