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Additional file 1. Interview guide.

An amendment to this paper has been published and can be accessed via the original article.

This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students’ unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the ‘failure to fail’ phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.

Insufficient professional development may lead to poor performance of healthcare professionals. Therefore, continuing education (CE) and continuing professional development (CPD) are needed to secure safe and good quality healthcare. The aim of the study was to investigate the hypothesized associations and their directions between pharmacists’ basic psychological needs in CE, their academic motivation, well-being, learning outcomes. Self-determination theory was used as a theoretical framework for this study. Data were collected through four questionnaires measuring: academic motivation, basic psychological needs (BPN), vitality and lifelong learning adaptability of pharmacists in the CE/CPD learning context. Structural equation modelling was used to analyze the data. Demographic factors like gender and working environment influenced the observed scores for frustration of BPN and factors like training status and working experience influenced the observed scores for academic motivation. A good model fit could be found only for a part of the hypothesized pathway. Frustration of BPN is positively directly related to the less desirable type of academic motivation, controlled motivation (0.88) and negatively directly related to vitality (− 1.61) and negatively indirectly related to learning outcomes in CE. Fulfillment or frustration of BPN are important predictors for well-being and learning outcomes. Further research should be conducted to discover how we can prevent these needs from being frustrated in order to design a motivating, vitalizing and sustainable CE/CPD system for pharmacists and other healthcare professionals. Basic psychological needs are very important predictors for well-being and learning outcomes. Further research should be conducted to discover how we can prevent these needs from being frustrated in order to design a motivating, vitalizing and sustainable CE/CPD system for pharmacists and other healthcare professionals.

The first national evaluation of undergraduate medical education in Finland was carried out by the Finnish Education Evaluation Centre (FINEEC) in 2016–2018. The evaluation covered all five universities that offer the Licentiate Degree in Medicine programme: Universities of Eastern Finland, Helsinki, Oulu, Tampere and Turku. The evaluation is based on the principles of enhancement-led evaluation, emphasising active participation and trust. Both the process and its results are intended to help education providers to identify the strengths, good practices and areas in need of development in undergraduate medical education. The evaluation aimed at producing an overall picture on the current state, strengths and challenges of undergraduate medical education, and developing recommendations that reflect the changing competence requirements in doctors’ work and their future operating environment. The evaluation team identified the following areas as strengths that apply to all five Medical Schools:* Undergraduate medical education programmes are regularly reviewed and developed; various drivers for changes have been identified and processes of quality management exist, and the Schools seem committed to improve their education continuously.* Each School has many good practices of education planning and implementation that others can share.* National collaboration is increasing, and joint analyses of core learning contents have started.* Student engagement is particularly strong; the students are involved in the development of education in all five Schools at all levels of studies through feedback and representatives.* All Schools provide decentralised clinical placements outside the university hospital and early patient contact, often in primary care. There is good collaboration with teaching units outside the university, especially in primary health care featuring enthusiastic teachers as role models.The core recommendations to support the development of undergraduate medical education are:* Defining the “Finnish Doctor”. To engage effectively with the forthcoming health and social care (SOTE) reforms, there must be a consensus on the skills, attitudes and role of a newly graduating doctor. Currently there is no national consensus about what is a “Finnish Doctor” – how they are educated and what they should master at graduation. The structure of medical curriculum varies between universities. Medical Schools need to take more of a leadership role in defining the “Finnish Doctor” and involve a range of stakeholders (patients, students, other health professions, employers) to develop a shared vision and agree on key curricular outcomes.* Curriculum mapping and alignment. Curriculum mapping – displaying the key elements of curriculum and the relationship between them – can make curriculum planning more effective, the scope and sequence of student learning explicit, and the result more transparent to all stakeholders. Medical Schools could then continue collaboration to align the curricula so that shared national programme outcomes can be taught, learnt and assessed with certainty.* Development of key skills. A doctor’s key task is diagnostic work with patients. Particularly important for learning, then, is assessment of clinical skills and reasoning in patient encounters with constructive feedback. Readiness to apply new technologies with a critical attitude, teamworking skills, and abilities to manage difficult situations constructively are also core competencies to be facilitated throughout undergraduate learning.* Learning environment. Increased medical student intake has coincided with organizational and budget changes, affecting student and staff well-being. Larger groups especially in the clinics increase teacher workload and decrease opportunity for hands-on experience and personal feedback. Medical Schools’ approaches to preventing, identifying and managing problems in student and staff well-being should be developed.* Valuing teacher skills. Medical School teachers balance between demands from teaching, clinic, research, and family. Finnish Medical Schools should explore ways of appreciating teaching and consider creating tenure tracks in medical teaching. Centres for medical education could support systematic provision of pedagogical training for all who teach medical students.Achieving changes required by the rapidly changing operating environment can be done while protecting the unique flavours of the five Medical Schools. The Faculties can collaborate to ensure that graduates are trained in the skills they need as fledgling practitioners, in further speciality training, when taking on roles in research, management, education or health policy, and for lifelong learning. Ultimately the changes will improve the quality of graduates, increase patient safety, and result in better medical care in Finland.

Lääketieteen peruskoulutus on arvioitu Suomessa ensi kertaa. Kansainvälisen arviointiryhmän tärkein ehdotus on, että suomalaisen lääkärin ydinosaaminen pitää määritellä selvästi. Opintojen rakenteen, oppimismenetelmien ja arvioinnin tulisi johtaa linjakkaasti tämän osaamisen hyvään hallintaan.

Objective. To explore the changes in motivation of Dutch pharmacists for Continuing Education (CE) in the Dutch CE system. Methods. Pharmacists’ motivation was measured across three time points with the Academic Motivation Scale, based on the Self-Determination Theory of motivation. The Latent Growth Modelling technique was used to analyze these data. Results. Over a period of 21 months, Controlled Motivation had increased and Relative Autonomous Motivation of Dutch pharmacists had decreased. Traineeship was the only demographic factor with a significant influence on the change in motivation. No subgroups with different trajectories could be identified. Conclusion. Relative Autonomous Motivation of Dutch pharmacists for CE decreases over time. This indicates a loss of Autonomous Motivation (“good” motivation) in favor of Controlled Motivation (“bad” motivation). Further research needs to be conducted to gain a better understanding of the association between pharmacist motivation and the features of the current CE system.

Findings mapped to GMCâ s domains of concern. (DOCX 30Â kb)

List of themes, descriptors and behaviours. (DOCX 40Â kb)

Table of papers included in the review. For each included paper the study reference, country, setting, number of students, research objectives, findings relevant to the review, type of study and pedagogical approach are provided. (DOC 226Â kb)

Complete search strategy. (DOCX 26Â kb)

Survey used in the study (English version). PDF 63 kb)

Interview schedule. (DOCX 18Â kb)

Interview guide. (DOCX 18 kb)

INTRODUCTION: Continuing education (CE) can support health care professionals in maintaining and developing their knowledge and competencies. Although lack of motivation is one of the most important barriers of pharmacists' participation in CE, we know little about the quality or the quantity of motivation. We used the self-determination theory, which describes autonomous motivation (AM) as originating from within an individual and controlled motivation (CM) as originating from external factors, as a framework for this study. Our aim was to obtain insight into the quality and quantity of pharmacists' motivation for CE. METHODS: The scores of 425 pharmacists on Academic Motivation Scale were subjected to K-means cluster analysis to generate motivational profiles. RESULTS: We unraveled four motivational profiles: (1) good quality with high AM/low CM, (2) high quantity with high AM/high CM, (3) poor quality with low AM/high CM, and (4) low quantity with low AM/low CM. Female pharmacists, pharmacists working in a hospital pharmacy, pharmacists working for more than 10 years, and pharmacists not in training were highly represented in the good-quality profile. Pharmacists working in a community pharmacy, pharmacists working for less than 10 years, and pharmacists in training were highly represented in the high-quantity profile. Male pharmacists were more or less equally distributed over the four profiles. The highest percentage of pharmacy owners was shown in the low-quantity profile, and the highest percentage of the nonowners was shown in the good-quality profile. DISCUSSION: Pharmacists exhibit different motivational profiles, which are associated with their background characteristics, such as gender, ownership of business, practice setting, and current training. Motivational profiles could be used to tailor CE courses for pharmacists.

INTRODUCTION: The interest in continuing education (CE) for pharmacists has increased because of patient safety issues, advancing science and the quick changes in the profession. Therefore, contemporary pharmaceutical care requires an effective and sustainable system for pharmacists to maintain and improve competencies. Although motivation plays an important role both as a facilitator (desire to learn) and a barrier (lack of motivation), there is little investigated about this specific factor. The aim of the study was to explore what factors influence pharmacists' participation in CE with a focus on motivation. METHODS: The theoretical framework was self-determination theory (SDT), which describes autonomous motivation (AM) representing motivation from an internal locus of causality, controlled motivation (CM) originating from an external locus of causality, and relative autonomous motivation (RAM) that measures the AM in an individual after correcting for the CM. The relationship between pharmacists' characteristics, especially their motivation (AM, CM and RAM) in CE, and their participation in CE activities was explored using the AMS-questionnaire and the Dutch online portfolio system. RESULTS: RAM was positively correlated with CE participation of pharmacists and explained 7.8% of the variance. The correlations between the independent variables AM and CM and CE hours were negative (-0.301 and -0.476, respectively). Other factors influencing CE participation were pharmacy school (6.8%), traineeship (10.9%), and work experience (7.8%). Pharmacists participated for 27.0 hours on average in CE during 11 months and preferred face-to-face-learning (85.5%) above e-learning (13.8%). DISCUSSION: Our findings show a positive relationship between RAM and CE participation. The current CE system is probably not conducive to stimulation of AM. Further research is needed to understand the factors that stimulate pharmacists' motivation and participation in CE.