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ObjectivesEarly professionalism education for first-year students is important for generating sound knowledge and attitudes towards medical professionalism. Of the many factors affecting professionalism and professional identity formation in medical students, career choice motivation is an understudied one. This study aimed to explore the relationship between the career choice motivations of first-year medical students and their understanding of professionalism.Settings and participantsA cross-sectional survey of 940 first-year clinical medicine students was conducted at China Medical University in September 2017 to explore students’ motivation to study medicine and its relationship with students’ understanding of professionalism. Demographics, career choice motivation and professionalism were obtained through paper questionnaires. Logistic regression analysis was used to analyse the association between career choice motivation and understanding of professionalism while controlling for potential demographic confounders.ResultsThe most common career choice motivations for first-year medical students (N=843) were interested in the health sciences, income and social status and advocating altruism. The most mentioned subdimensions of professionalism were accountability, pursuit of excellence and compassion. There were significant differences in the understanding of professionalism among students with different career choice motivations.ConclusionFirst-year medical students with different motivations to study medicine also have different understandings of professionalism. Medical educators can explore motivations to learning medicine as a new entry point to providing professionalism education for newly enrolled medical students.

Mental health problems are frequent obstacles in medical students’ careers as doctors. Given that previous studies overlook the mediation of stress perception, the current study expanded previous goal orientation researches by addressing an unexplored mechanism. This study aims to examine the mediational roles of stress perception (perceived stressors and stress-related cognition) on the relationship between achievement goal orientation and depression in medical students. A total of 1,015 Chinese 2-year medical students completed a multi-section questionnaire. Hypotheses were examined by structural equation modeling. The findings suggest that performance-avoidance goal orientation and perceived stressors both demonstrated direct facilitative effects on depression, whereas stress-related cognition demonstrated direct obstructive effects on depression. Both perceived stressors and stress-related cognition mediated the relationship between achievement goal orientation and depression. The findings spark a new perspective on motivational intervention that assist students in adopting mastery-approaching strategy as well as ways of coping with stressful academic situations. Identifying students with achievement goal orientation and providing them with the appropriate supportive services may help them to manage stress and mitigate or prevent depression.

Objective Burnout poses as an understudied challenge to professionalism, and social support may explain their relationship. We sought to investigate the role of social support (moderating or mediating) in the association between physician burnout and professionalism (with four behavioral domains: respect, integrity, excellence, responsibility). Methods We invited 4100 physicians from nine tertiary hospitals in Liaoning province, China, during February 2017, to participate in a cross-sectional survey. Professionalism, burnout, and social support were respectively assessed using three standardized tools. Descriptive statistics, multivariable linear regression, and ordinal logistic regression were used to analyze the data. Results 3506 physicians (85.5%) effectively completed the survey. After controlling for potential confounding factors, burnout was associated with lower professionalism (β = −0.65, SE = 0.07), particularly in respect (OR = 0.51, 95%CI: 0.41–0.64) and responsibility (OR=0.72, 95%CI: 0.57–0.90). However, there was no statistically significant association between burnout and integrity or excellence. Social support was associated with higher professionalism ((β = 0.24, SE = 0.02) and all of its behavioral domains and played a partial mediating effect on the association between burnout and professionalism. Conclusion Social support partially mediates the relationship between physician burnout and behavior-based professionalism. Practice implications Addressing burnout and promoting social support could be integral in fostering physician professionalism in the healthcare setting.

Background: Medical students struggle with heavy workloads and face unique time management challenges, calling for insight on medical students’ time use in out-of-class activities and related psychological factors. Objectives: To investigate Chinese medical students’ time use in out-of-class activities and its association with self-efficacy and perceived stress. Design: 940 second-year medical students were invited to participate in the survey. A questionnaire was developed to investigate the amount of time participants spent on out-of-class activities. Two existing instruments were used to assess participants’ self-efficacy and perceived stress. Descriptive statistics and logistic regression were used to analyze the data. Results: 686 students (72.98%) completed the survey. On average, students spent about 14.4 hours per week (HPW) preparing for class and studying, 13.8 HPW on leisure and recreation, 4.8 HPW on physical exercise, 4.1 HPW on student clubs, 1.9 HPW on volunteering, and 1.9 HPW on part-time jobs on/off-campus. After controlling for demographic factors, higher self-efficacy was associated with more time preparing for class and studying (OR = 1.29, 95%CI: 1.10 ~ 1.52). Higher perceived stress was associated with less time preparing for class and studying (OR = 0.84, 95%CI: 0.72 ~ 0.98), exercising (OR = 0.82, 95%CI: 0.69 ~ 0.97), and volunteering (OR = 0.81, 95%CI: 0.67 ~ 0.97). Conclusions: Chinese medical students reported more time spent on preparing for class and studying and less time spent on volunteering and part-time jobs on/off-campus. Time spent preparing for class and studying was associated with higher self-efficacy and lower perceived stress, while perceived stress was also associated with less time spent on physical exercise and volunteering. Medical schools may need to employ measures to develop their students’ self-efficacy and maintain a relatively low level of perceived stress, especially in students who also have a low level of self-efficacy.

Ubiquitin-specific protease 11 (USP11) is a deubiquitinating enzyme that exerts its biological functions by regulating multiple signaling pathways such as p53, NF-κB, TGF-β, and Hippo. A large body of evidence supports a link between UPS11 and tumorigenesis. However, the clinical significance and biological function of USP11 in hepatocellular carcinoma (HCC) remains unclear. Here, USP11 expression was assessed by immunohistochemistry in a pilot series of 71 HCC clinical samples, and the association between USP11 expression and clinicopathological features and overall survival time was analyzed. The cytoplasmic expression rate of USP11 was higher in non-cancerous tissue than that in cancer tissue (36.6 vs. 12.7%, P = 0.001), whereas the nuclear expression rate of USP11 was lower in non-cancerous tissue (5.6 vs. 69.0%, P

ObjectivesTo administer a cross-cultural adaptation of the Team Interaction Scale (TIS), test its psychometric properties and investigate influencing factors of team interactions in a physician population in Chinese tertiary hospitals.DesignCross-sectional survey.SettingsTwo rounds of surveys, a pilot and a large sampling survey, were conducted in two and nine tertiary hospitals, respectively, in Liaoning Province, China.ParticipantsIn the pilot survey, 363 of 390 physicians sampled were included in the analysis, resulting in an effective response rate of 93.08%. In the large sampling survey, the effective response rate was 89.10% (3653 of 4100 physicians).Outcome measuresThe TIS and a short version of a burn-out scale were administrated to assess the physician’s team interaction and burn-out. Psychometric properties of TIS were tested by confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and internal consistency analysis. Gender, age, discipline, education level, professional title, hospital scale and burn-out were explored as influencing factors with independent samplet-tests, one-way analyses of variance and a correlation analysis.ResultsBased on CFA, a 17-item modified scale was developed following the pilot survey. In the large sampling survey, EFA was conducted with half of the samples, producing six dimensions: ‘Communication’, ‘Coordination’, ‘Mutual help’, ‘Team goals’, ‘Work norms’ and ‘Cohesion and conflict resolution’. Fit of the modified model was confirmed by CFA with the other half of the samples (root mean square error of approximation=0.067, Comparative Fit Index=0.98, Normed Fit Index=0.97, Goodness of Fit Index=0.94, Adjusted Goodness of Fit Index=0.92). A high Cronbach’s α coefficient of 0.98 demonstrated reliability of the modified scale. The Team Interaction Score was significantly lower in younger physicians, in men, in paediatricians and in physicians from larger-scale tertiary hospitals. Team Interaction Scores were negatively associated with burn-out.ConclusionsThe adapted TIS, containing 17 items and six dimensions, was reliable and valid for Chinese tertiary hospital physicians. To address physician burn-out, team interaction should be highlighted.

Background Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments’ measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations. Methods A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990–2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument’s usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee’s criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments. Results After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar’s instrument for nursing students, Nurse Practitioners’ Roles and Competencies Scale, and Perceived Faculty Competency Inventory. Conclusion Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Background Although it has been nearly 15 years since the Medical Professionalism in the New Millennium: A Physician Charter (the Physician Charter) was proposed to reaffirm medical professionalism in response to the new challenges in healthcare delivery in the new century, the manner in which Chinese medical students agree with and fulfill the principles and responsibilities of professionalism defined in the Physician Charter still remains unknown. Methods In March 2016, 748 fifth-year medical students from China Medical University (CMU) participated in a survey in which they indicated their rate of agreement with and manner of fulfillment of the principles and responsibilities defined in the Physician Charter using a 10-point Likert scale. The data were then analyzed by t-tests, exploratory factor analysis, and multiple linear regressions. Results The total score of agreement with the Physician Charter was significantly higher than that of fulfillment (p

This article was migrated. The article was marked as recommended. Purpose: To create a framework for analyzing student narratives relating to professional growth in their third year of medical school. Method: Using a qualitative approach, we examined 32 student narratives in a professionalism course, and analyzed them in three phases: 1) open coding 2) categorical consolidation and 3) thematic analysis. Result: Three main themes were identified in third year student narratives: 1) Physician-Patient & Family Relationships 2) Learning Environment and 3) Self-Identity in Relationship to Teams. Based on student narratives the authors created a framework for narrative analysis referencing work from learning development theory and prior understanding of professional formation. Conclusion:A professional growth framework was developed using qualitative analysis of students' voices in self-reflection narratives during third year clinical clerkships. We believe this framework will be helpful to educators in understanding the process of professional formation and be useful as an analysis scheme for further studies of professional formation.

Presently, there is no recommendation on how to assess functional status of chronic obstructive pulmonary disease (COPD) patients. This study aimed to summarize and systematically evaluate these measures.Studies on measures of COPD patients' functional status published before the end of January 2015 were included using a search filters in PubMed and Web of Science, screening reference lists of all included studies, and cross-checking against some relevant reviews. After title, abstract, and main text screening, the remaining was appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist. All measures from these studies were rated according to best-evidence synthesis and the best-rated measures were selected.A total of 6447 records were found and 102 studies were reviewed, suggesting 44 performance-based measures and 14 patient-reported measures. The majority of the studies focused on internal consistency, reliability, and hypothesis testing, but only 21% of them employed good or excellent methodology. Their common weaknesses include lack of checks for unidimensionality, inadequate sample sizes, no prior hypotheses, and improper methods. On average, patient-reported measures perform better than performance-based measures. The best-rated patient-reported measures are functional performance inventory (FPI), functional performance inventory short form (FPI-SF), living with COPD questionnaire (LCOPD), COPD activity rating scale (CARS), University of Cincinnati dyspnea questionnaire (UCDQ), shortness of breath with daily activities (SOBDA), and short-form pulmonary functional status scale (PFSS-11), and the best-rated performance-based measures are exercise testing: 6-minute walk test (6MWT), endurance treadmill test, and usual 4-meter gait speed (usual 4MGS).Further research is needed to evaluate the reliability and validity of performance-based measures since present studies failed to provide convincing evidence. FPI, FPI-SF, LCOPD, CARS, UCDQ, SOBDA, PFSS-11, 6MWT, endurance treadmill test, and usual 4MGS performed well and are preferable to assess functional status of COPD patients.