Search

Abstract Background Medical professionalism is a core competency for medical students during clerkships for further professional development. Given that the behavior-based framework could provide clear insight and is easy to assess, the study aimed to create a self-administered scale to measure the professional behaviors of medical students during their clerkships. Methods A comprehensive literature review on medical professional behaviors in English or Chinese and Delphi interviews were used to develop the initial version of the Self-Administered Scale for Professional Behavior of Medical Students During Clerkships. The reliability and validity analysis based on a survey of medical students from China, Cronbach’s α calculations, and Confirmatory Factor Analysis (CFA) specifically were conducted to finalize the scale. The associations of professional behaviors with gender, medical programs, and clerkship duration were examined using Wilcoxon rank-sum tests. Results We included 121 studies and extracted 57 medical professionalism assessment tools, initially forming a pool of 48 items. To refine these items, eighteen experts participated in two rounds of Delphi interviews, ultimately narrowing down the item pool to 24 items. A total of 492 participants effectively completed the questionnaire. One item was removed due to its correlated item-total correlation (CITC) value, resulting in a final scale containing 23 items with six domains: Respect, Altruism, Communication and Collaboration, Integrity, Duty, and Excellence. The overall Cronbach’s alpha value was 0.98, ranging from 0.88 to 0.95 for each domain. The fit indices (χ2/df = 4.07, CFI = 0.96, TLI = 0.95, RMSEA = 0.08, and SRMR = 0.02) signified a good fit for the six-domain model. Medical students’ professional behavior was significantly associated with gender (p = 0.03) and clerkship duration (p = 0.001). Conclusion The scale was demonstrated to be reliable and valid in assessing the professional behaviors of Chinese medical students during clerkships.

Background: The COVID-19 pandemic introduced unprecedented challenges to medical education systems and medical students worldwide, making it necessary to adapt teaching to a remote methodology during the academic year 2020–2021. The aim of this study was to characterize the association between medical professionalism and dropout intention during the pandemic in Peruvian medical schools. Methods: A cross-sectional online-survey-based study was performed in four Peruvian medical schools (two public) during the academic year 2020–2021. Medical students, attending classes from home, answered three scales measuring clinical empathy, teamwork, and lifelong learning abilities (three elements of medical professionalism) and four scales measuring loneliness, anxiety, depression, and subjective wellbeing. In addition, 15 demographic, epidemiological, and academic variables (including dropout intention) were collected. Variables were assessed using multiple logistic regression analysis. Results: The study sample was composed of 1107 students (390 male). Eight variables were included in an explanatory model (Nagelkerke-R2 = 0.35). Anxiety, depression, intention to work in the private sector, and teamwork abilities showed positive associations with dropout intention while learning abilities, subjective wellbeing, studying in a public medical school, and acquiring a better perception of medicine during the pandemic showed a negative association with dropout intention. No association was observed for empathy. Conclusions: Each element measured showed a different role, providing new clues on the influence that medical professionalism had on dropout intention during the pandemic. This information can be useful for medical educators to have a better understanding of the influence that professionalism plays in dropout intention. [ABSTRACT FROM AUTHOR]

Background: Medical professionalism is a core competency for medical students during clerkships for further professional development. Given that the behavior-based framework could provide clear insight and is easy to assess, the study aimed to create a self-administered scale to measure the professional behaviors of medical students during their clerkships. Methods: A comprehensive literature review on medical professional behaviors in English or Chinese and Delphi interviews were used to develop the initial version of the Self-Administered Scale for Professional Behavior of Medical Students During Clerkships. The reliability and validity analysis based on a survey of medical students from China, Cronbach's α calculations, and Confirmatory Factor Analysis (CFA) specifically were conducted to finalize the scale. The associations of professional behaviors with gender, medical programs, and clerkship duration were examined using Wilcoxon rank-sum tests. Results: We included 121 studies and extracted 57 medical professionalism assessment tools, initially forming a pool of 48 items. To refine these items, eighteen experts participated in two rounds of Delphi interviews, ultimately narrowing down the item pool to 24 items. A total of 492 participants effectively completed the questionnaire. One item was removed due to its correlated item-total correlation (CITC) value, resulting in a final scale containing 23 items with six domains: Respect, Altruism, Communication and Collaboration, Integrity, Duty, and Excellence. The overall Cronbach's alpha value was 0.98, ranging from 0.88 to 0.95 for each domain. The fit indices (χ2/df = 4.07, CFI = 0.96, TLI = 0.95, RMSEA = 0.08, and SRMR = 0.02) signified a good fit for the six-domain model. Medical students' professional behavior was significantly associated with gender (p = 0.03) and clerkship duration (p = 0.001). Conclusion: The scale was demonstrated to be reliable and valid in assessing the professional behaviors of Chinese medical students during clerkships. [ABSTRACT FROM AUTHOR]

Background: Professionalism is an important prerequisite for the quality of medical care with specific competencies anchored in the National Competence-Based Learning Objectives Catalogue Medicine 2.0. To date, there are hardly any explicit teaching formats at German universities to achieve these. A longitudinal curriculum for the development of medical professionalism (LongProf) has now been developed, implemented and evaluated at Jena University Hospital. Methods: The target group of the four-semester-curriculum were medical students from the fifth semester onwards. After a nine-month conception phase, a total of nine courses (6 teaching units each) took place from the winter semester 2021/22. Students also had the opportunity to interact with experienced doctors in mentoring sessions. The courses were evaluated by the participating students (n=23) in terms of acceptance and individually perceived professional development through quantitative surveys and qualitative focus group interviews. Results: The qualitative and quantitative evaluation revealed mostly positive feedback (mean >7/9). Students stated that the courses had provided them with lasting support in developing their own medical professionalism and in coping with the demands of their studies. The personal and long-term relationship building between students and teachers was considered particularly helpful. Discussion and conclusion: A multi-semester curriculum opens up ways for implementing the development of medical professionalism in medical studies. A trusting relationship between students and teachers, made possible by the longitudinal structure, is seen as conducive to the development of an individual medical identity. The curriculum is a useful complement to regular medical studies. [ABSTRACT FROM AUTHOR]

Introduction In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers.Discussion This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling.Conclusion Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.

BACKGROUND: Medical professionals are key components of child maltreatment surveillance. Updated estimates of reporting rates by medical professionals are needed. METHODS: We use the National Child Abuse and Neglect Data System (2000-2019) to estimate rates of child welfare investigations of infants stemming from medical professional reporting to child welfare agencies. We adjust for missing data and join records to population data to compute race/ethnicity-specific rates of infant exposure to child welfare investigations at the state-year level, including sub-analyses related to pregnant/parenting peoples substance use. RESULTS: Between 2010 and 2019, child welfare investigated 2.8 million infants; ∼26% (n=731,705) stemmed from medical professionals reports. Population-adjusted rates of these investigations stemming doubled between 2010 and 2019 (13.1-27.1 per 1000 infants). Rates of investigations stemming from medical professionals reports increased faster than did rates for other mandated reporters, such as teachers and police, whose reporting remained relatively stable. In 2019, child welfare investigated ∼1 in 18 Black (5.4%), 1 in 31 Indigenous (3.2%), and 1 in 41 White infants (2.5%) following medical professionals reports. Relative increases were similar across racial groups, but absolute increases differed, with 1.3% more of White, 1.7% of Indigenous, and 3.1% of Black infants investigated in 2019 than 2010. Investigations related to substance use comprised ∼35% of these investigations; in some states, this was almost 80%. DISCUSSION: Rates of child welfare investigations of infants stemming from medical professional reports have increased dramatically over the past decade with persistent and notable racial inequities in these investigations.

Objective To investigate and analyze the understanding and cognition of medical professionalism among medical students in Shanghai universities. Methods A total of 574 full-time medical students from some medical colleges in Shanghai were selected. A self-designed questionnaire was used to conduct the survey. According to the experience of participating in volunteer work or anti-epidemic front-line work, medical students were divided into participating group (362) and non-participating group (212),and the influence of relevant work experience on the recognition of the importance of medical professionalism connotation was further analyzed. Results There were statistically significant differences in the cognition of Physician Declaration and Chinese Physician Declaration among medical students with different academic qualifications (P＜0. 05) . 46. 2% of medical students believed that the outbreak of the epidemic did not affect their personal career planning, and 37. 3% of medical students strengthened their determination to study medicine after the epidemic and were ready to devote themselves to the medical cause. 37. 6% of medical students believed that the epidemic had a great impact on personal professionalism, deepened their intuitive feelings about medical professionalism, and would put it into practice. 46. 5% of medical students realized the importance of medical professionalism to the development of medical education and health care. Medical students believed that the top three most important items of medical professionalism were “respect for patients” (87. 1%),“keeping calm in difficult times” (87. 3%) and “solving the gap between their knowledge and skills” (86. 2%),while the last three items were “speaking on behalf of patients” (58. 9%),“treating patients on call” (47. 9%) and “accepting inconvenient requirements for themselves to meet patients” (41. 5%) . The recognition of the importance of the connotation of medical professionalism in the participating group was significantly higher than that in the non-participating group, and the difference was statistically significant (P＜0. 01) . Conclusion Medical students′ understanding of medical professionalism is still insufficient, and the spirit of altruism is relatively lacking. However, most medical students can realize the importance of medical professionalism in their own growth, development and professional practice. [ABSTRACT FROM AUTHOR]

Objectives Well-formed communication between dentists and dental technicians is an important factor for the fabrication of dental prostheses. Numerous articles have highlighted the lack of sufficient communication between dental clinics and laboratories. The present study aimed to assess the communication between dentists and dental technicians in Iran. Methods In this cross-sectional study, a structured questionnaire containing 23 questions about the effectiveness of communication between dentists and dental laboratories was distributed among 154 dental technicians. After data collection, the data were entered into SPSS-24 software and analyzed. Independent t-tests and analysis of variance (ANOVA) were used to analyze the data with independent variables. Results The communication between dental laboratory and clinic had a significant relationship with gender, job characteristics, laboratory location, and laboratory activity in all areas (p-value <0.001). Moreover, 77.3% of the participants perceived their communication as constructive and encouraging, and 50% believed that the dentist followed their opinion after consulting with the dental prosthesis laboratory. Conclusion Training in medical professionalism, as an essential element contributing to communication between dentists and dental technicians, must be included in the dental schools’ curricula. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodResultsConclusionThe shift in medical professionalism now considers the well-being of physicians, given the prevalence of burnout and the importance of work-life balance. To reconsider the question ‘Why do doctors work for the patient?’ and explore the meaning of working as a physician, this study adopts the concept of ‘yarigai,’ which represents fulfillment and motivation in meaningful work. The authors’ research questions are: How do doctors recount experiences of yarigai in caring for patients? What kind of values are embodied in their stories about yarigai?They adopted narrative inquiry as the methodology for this study. They interviewed 15 doctors who were recognized by their colleagues for their commitment to patient-centered care or had demonstrated yarigai in caring for patients. The semi-structured interviews were conducted face-to-face with each participant by the Japanese researchers, yielding 51 cases of patient-doctor interactions. After grouping the interview data, they translated the cases into English and identified four representative cases to present based on the set criteria.From the 51 case studies, they constructed four representative narratives about the yarigai as a physician. Each of them spoke of (1) finding positive meaning in difficult situations, (2) receiving gifts embodying ikigai, (3) witnessing strength in a seemingly powerless human being, and (4) cultivating relationships that transcend temporal boundaries, as being rewarding in working as a physician. The main results of the study, which are the narratives, are described in the main body of the paper.The stories on yarigai gave intrinsic meanings to their occupational lives, which can be informative for students, residents, and young physicians when contemplating the meaning of their work as doctors. Rather than demanding selfless dedication from physicians towards patients, they believe it more important to foster yarigai, derived from the contribution to the well-being of others through patient care. [ABSTRACT FROM AUTHOR]

In the contemporary world pharmaceuticals have become a go-to answer to a growing number of questions. This process of pharmaceuticalization gives rise to a concern with the increasing influence of the pharmaceutical industry on physicians' decision-making. Critics suggest that companies' for-profit-interests might compromise the integrity of medical practice. This article employs qualitative research methodology to explore how Russian physicians deal with the industry's efforts to expand and shape the use of pharmaceuticals. By bridging perspectives of social studies of science and sociology of professions, we offer a contextualized account of physicians' daily practices and interpretations related to pharmaceuticalization. The findings question conventional assumptions of physician-industry relations and allow to delineate a new form of medical professionalism that emerges in the context of pharmaceuticalization and cannot be reduced to either "resisting" industry marketing activities or "giving in" to them and thus corrupting biomedical expertise. Instead, the ways in which physicians navigate abundant sources of knowledge and use industry resources to overcome constraints of their organizational environment attest to mundane forms of agency exercised by physicians in their relations with industry. [ABSTRACT FROM AUTHOR]

BACKGROUND: Professionalism is one of the fundamental traits which includes behaviors, commitments, standards, and goals that helps define a profession. OBJECTIVE: This study aimed to assess the attitude of dental students and graduates regarding the practice of professionalism in dentistry using the Professionalism Mini Evaluation Exercise (P-MEX) questionnaire. METHOD: This cross-sectional study was conducted amongst the dental undergraduates, lecturers and postgraduate faculty. Views regarding professionalism were assessed using the P-MEX. The 24-questions based survey form is comprised of questions related to doctor and patient relationship skills, reflective abilities, time management, and lastly, interprofessional relationship expertise. Data was analyzed using SPSS version 23. Descriptive statistics were done using mean and SD, whilst associations between responses were assessed using Mann-Whitney U and Kruskal-Wallis tests. P value less than 0.05 was considered significant. RESULTS: From a total of 201 participants, 95 (47.3%) were males and 106 (52.7%) were females. Statistically significant association was seen between time management, reflective skills, and interpersonal skills with gender, as well as the domains of P-MEX and years of education. CONCLUSION: The use of P-MEX provides a valid confirmation for the assessment and awareness of professionalism amongst the dental faculty and students. Females demonstrated higher traits of professionalism as compared to males. The findings from the current study identify that students and faculty members had sufficient awareness regarding professionalism and the practice of professionalism was routinely followed. [ABSTRACT FROM AUTHOR]

This Article provides an empirical analysis of all free movement of doctors cases decided by the CJEU. The aim of the Article is twofold: to provide a 'characterisation' of the type of doctors who rely on free movement law, and to make a link between their reliance on free movement law and the concept of medical professionalism. In what circumstances, and with what purpose, do doctors rely on free movement law? And does their reliance on free movement law pose a risk to medical professionalism? The analysis shows that most cases before the CJEU focussed on the expertise and qualifications of doctors. Many cases were brought by groups of doctors or medical professional associations. In most cases, the aim of the doctor's reliance on free movement law was to defend medical professionalism. Nevertheless, some recent cases show that doctors do rely on free movement law to restrict their accountability towards patients or national healthcare systems. Moreover, these cases show that arguments based on free movement law are relied on in a broader range of non-specialised courts or tribunals. This makes it important that national courts continue to engage in a dialogue with the CJEU. [ABSTRACT FROM AUTHOR]

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

IntroductionTeaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students.MethodsTo validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes.ResultsQuantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9–1 for relevance and 0.7–1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as “worthless/worthwhile” were replaced with “not important/important”); and (ii) suggestion of the addition of social media in the construct of subjective norms.DiscussionThe proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

Abstract Introduction Professional identity formation (PIF) is recognized worldwide as an outcome of medical education grounded in the psychology of adult development and the literature on medical professionalism. However, instruments to assess and support PIF are scarce. The Professional Identity Essay (PIE) is an open-ended question assessment of PIF that elicits short narrative responses from learners and that can be analyzed to provide formative feedback and an overall stage of development. In this study, our aim was to translate and adapt the PIE to Brazilian Portuguese. Methods We followed a systematic procedure for the translation and cross-cultural adaptation of the instrument. A pilot study was conducted with medical students from the University of São Paulo. After providing individual formative feedback, we administered an online questionnaire to the Brazilian students to better understand the consequences of using the PIE. Content analyses of qualitative data were performed, we employ manifest content analysis, and the categories of analysis emerged from the participants’ speeches. Results Students found the instrument’s questions easy to interpret and self-reflective. It also gave students the opportunity to consider their PIF. The PIE was perceived as reliable and brought more awareness of the students’ own processes in addition to a sense of capability to foster their own development. In the same way, the students emphasized the importance of being helped in this process. Conclusion We found sufficient evidence of the validity of the PIE in terms of content, face validity, and consequences of use. The PIE enhances self-assurance in PIF through formative assessment and is sensitive to different cultures, making it a potential tool for educators.

Background/purpose: Improved communication can optimize treatment outcomes and patient satisfaction. Findings emphasize the need for tailored communication strategies based on patient characteristics. Implementing communication courses can enhance patient-centered care and reduce conflicts. Therefore, this study examined the feasibility of integrating doctor-patient communication education in Taiwan's dental education system. Materials and methods: Using interviews and questionnaires, we conducted descriptive statistics and generalized linear mixed-effects model analysis on the importance of doctor-patient communication from the dentist and patient perspectives. Results: More than 600 patient surveys and four interviewed dentists with 20+ years of experience stressed doctor-patient communication in dentistry. Patients' age and income were positively related to the emphasis on physician-patient communication but negatively associated with dental assistants' communication. Dentists valued communication education but differed in its execution and importance. Conclusion: It is recommended to initiate dentist-patient communication education during university studies and continue its practice to adapt to the changing societal dynamics. Individuals with higher socioeconomic status and older age show a greater appreciation for dentist-patient communication, potentially driven by self-promotion, thereby highlighting the diverse nature of doctor-patient relationships. Based on our findings, we suggest to implement the doctor-patient communication courses in Taiwan.

Abstract Background There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version. Methods A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach’s alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument. Results A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach’s alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX. Conclusion The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education. Trial registration 2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.

Background: The COVID-19 pandemic introduced unprecedented challenges to medical education systems and medical students worldwide, making it necessary to adapt teaching to a remote methodology during the academic year 2020–2021. The aim of this study was to characterize the association between medical professionalism and dropout intention during the pandemic in Peruvian medical schools. Methods: A cross-sectional online-survey-based study was performed in four Peruvian medical schools (two public) during the academic year 2020–2021. Medical students, attending classes from home, answered three scales measuring clinical empathy, teamwork, and lifelong learning abilities (three elements of medical professionalism) and four scales measuring loneliness, anxiety, depression, and subjective wellbeing. In addition, 15 demographic, epidemiological, and academic variables (including dropout intention) were collected. Variables were assessed using multiple logistic regression analysis. Results: The study sample was composed of 1107 students (390 male). Eight variables were included in an explanatory model (Nagelkerke-R2 = 0.35). Anxiety, depression, intention to work in the private sector, and teamwork abilities showed positive associations with dropout intention while learning abilities, subjective wellbeing, studying in a public medical school, and acquiring a better perception of medicine during the pandemic showed a negative association with dropout intention. No association was observed for empathy. Conclusions: Each element measured showed a different role, providing new clues on the influence that medical professionalism had on dropout intention during the pandemic. This information can be useful for medical educators to have a better understanding of the influence that professionalism plays in dropout intention.

Abstract Background An increasing number of studies on physicians’ professionalism have been done since the 2002 publication of Medical Professionalism in the New Millennium: A Physician Charter. The Charter proposed three fundamental principles and ten responsibilities. However, most studies were done in developed countries, and few have been done in China. Additionally, few studies have examined the effect of patient-centered hospital culture (PCHC) on physicians’ professionalism. We aimed to investigate physicians’ medical professionalism in public hospitals in China, and to assess mediating effect of professional attitudes in the relationship of PCHC with professional behaviours. Methods Self-administered questionnaires including professional attitudes (20 items) and behaviours (10 items) survey and PCHC scale (22 items) were given to clinical physicians in five public hospitals, China. The mediating effect of professional attitudes in the relationship of PCHC with professional behaviours was tested. Result 232 valid questionnaires were collected. More than 90% (208) respondents agreed with 15 of 20 specific statements on medical professionalism. As for the responsibility of improving quality of care, 54 (23%) respondents disagreed with reporting of incompetent colleagues and as for the responsibility of maintaining professional competence, 49 (21%) disagreed with recertification. More than 185 (83%) respondents reported that they sometimes, usually, or always showed the four positive behaviours on the questionnaire, and 173 (77%) reported that they never showed the six negative behaviours. Mediating effect analysis revealed that two dimensions of PCHC (i.e. value/institution culture and behaviour/material culture) had a significant positive impact on physicians’ professional behaviour, and professional attitude played a complete mediation role between them, but another dimension of PCHC (i.e. negative evaluation of hospital) directly affected professional behaviour without influencing professional attitude. Conclusion Chinese physicians showed positive professional attitudes and behaviours. Different dimensions of PCHC affected physicians’ attitudes and behaviours in different ways.

Purpose This study aimed to clarify the attitudes, behaviors, and learning experiences of first-year medical students participating in a nursing practice training aimed at enhancing their professionalism. Methods A questionnaire survey was conducted among first-year medical students after their nursing practical training to understand their learning experiences. Descriptive statistics was performed for each questionnaire item. For free-text responses, descriptions were grouped by input data with similar content and meaning, and analyzed qualitatively. Others’ evaluation and self-evaluation were analyzed quantitatively. Results Most students were actively engaged and fulfilled in the training. The free comments generated these categories: “nursing care,” “roles of nurses,” “patient impressions,” “multidisciplinary cooperation,” “communication,” and “what is required of physicians. On the first day, all items evaluated had higher mean scores in the others’ evaluation than in the self-evaluation. On the second day, for “maintains standards of personal appearance (including uniform, hair, and name tag),” the others’ evaluation means were higher than the self-evaluation means. T-tests showed a significant difference in “maintains standards of personal appearance (including uniform, hair, and name tag)” (t=-2.103, degrees of freedom [df]=71.104, p

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

Improved communication can optimize treatment outcomes and patient satisfaction. Findings emphasize the need for tailored communication strategies based on patient characteristics. Implementing communication courses can enhance patient-centered care and reduce conflicts. Therefore, this study examined the feasibility of integrating doctor-patient communication education in Taiwan's dental education system. Using interviews and questionnaires, we conducted descriptive statistics and generalized linear mixed-effects model analysis on the importance of doctor-patient communication from the dentist and patient perspectives. More than 600 patient surveys and four interviewed dentists with 20+ years of experience stressed doctor-patient communication in dentistry. Patients' age and income were positively related to the emphasis on physician-patient communication but negatively associated with dental assistants' communication. Dentists valued communication education but differed in its execution and importance. It is recommended to initiate dentist-patient communication education during university studies and continue its practice to adapt to the changing societal dynamics. Individuals with higher socioeconomic status and older age show a greater appreciation for dentist-patient communication, potentially driven by self-promotion, thereby highlighting the diverse nature of doctor-patient relationships. Based on our findings, we suggest to implement the doctor-patient communication courses in Taiwan. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version. Methods: A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach's alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument. Results: A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach's alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX. Conclusion: The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education. Trial registration: 2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital. [ABSTRACT FROM AUTHOR]

Background: An increasing number of studies on physicians' professionalism have been done since the 2002 publication of Medical Professionalism in the New Millennium: A Physician Charter. The Charter proposed three fundamental principles and ten responsibilities. However, most studies were done in developed countries, and few have been done in China. Additionally, few studies have examined the effect of patient-centered hospital culture (PCHC) on physicians' professionalism. We aimed to investigate physicians' medical professionalism in public hospitals in China, and to assess mediating effect of professional attitudes in the relationship of PCHC with professional behaviours. Methods: Self-administered questionnaires including professional attitudes (20 items) and behaviours (10 items) survey and PCHC scale (22 items) were given to clinical physicians in five public hospitals, China. The mediating effect of professional attitudes in the relationship of PCHC with professional behaviours was tested. Result: 232 valid questionnaires were collected. More than 90% (208) respondents agreed with 15 of 20 specific statements on medical professionalism. As for the responsibility of improving quality of care, 54 (23%) respondents disagreed with reporting of incompetent colleagues and as for the responsibility of maintaining professional competence, 49 (21%) disagreed with recertification. More than 185 (83%) respondents reported that they sometimes, usually, or always showed the four positive behaviours on the questionnaire, and 173 (77%) reported that they never showed the six negative behaviours. Mediating effect analysis revealed that two dimensions of PCHC (i.e. value/institution culture and behaviour/material culture) had a significant positive impact on physicians' professional behaviour, and professional attitude played a complete mediation role between them, but another dimension of PCHC (i.e. negative evaluation of hospital) directly affected professional behaviour without influencing professional attitude. Conclusion: Chinese physicians showed positive professional attitudes and behaviours. Different dimensions of PCHC affected physicians' attitudes and behaviours in different ways. [ABSTRACT FROM AUTHOR]

Background: The recent rapid developments in medical science and technologies have brought about powerful medical tools; however, the professional commitment has failed to keep pace. Professionals' reluctance or failure to practice professional behavior has significantly challenged society's trust in professionalism. Consistent assessment of the profession, at least through measuring the capabilities and encouraging the elimination of shortcomings, can serve as an effective tool to preserve or restore this trust. Numerous assessment methods are recommended to measure the level of professionalism among the members of the medical society. Sometimes, professionalism is defined using shared values and sometimes various lists of professional behaviors are suggested. However, no comprehensive definition has been proposed for professionalism. Professionalism is normally individual. This study sought to provide a comprehensive definition of professionalism and accordingly explains organizational professionalism. In addition, it tried to define profession assessment through a non-systematic review of online resources using Web of Science, Science Direct, and PubMed databases. Professionalism is a belief system or a driving force to create these lists to improve healthcare, according to which professionalism requires collective action. The philosophy underlying the common standards of physicians regarding the patient-physician relationship confirms the importance of teamwork and organizational professionalism. Following professional autonomy, assessment of the members of a profession is carried out via self-assessment. Meanwhile, the continuation of the self-assessment system entails patients' trust in their physician and society's trust in the profession of medicine. Furthermore, the medical profession should operate with more transparency, thus the society can feel that the self-assessment is really effective. Thus, constant and dynamic self-assessment is started with the physicians and expanded through the clinical team. The profession should administer systematic professionalism in all dimensions of the health system. In addition, it should guard its self-assessment privileges obtained from society and seek the assistance of ordinary individuals in society, patients, and experts in fulfilling this task. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the attitudes, behaviors, and learning experiences of first-year medical students participating in a nursing practice training aimed at enhancing their professionalism. Methods: A questionnaire survey was conducted among first-year medical students after their nursing practical training to understand their learning experiences. Descriptive statistics was performed for each questionnaire item. For free-text responses, descriptions were grouped by input data with similar content and meaning, and analyzed qualitatively. Others’ evaluation and self-evaluation were analyzed quantitatively. Results: Most students were actively engaged and fulfilled in the training. The free comments generated these categories: “nursing care,” “roles of nurses,” “patient impressions,” “multidisciplinary cooperation,” “communication,” and “what is required of physicians. On the first day, all items evaluated had higher mean scores in the others’ evaluation than in the self-evaluation. On the second day, for “maintains standards of personal appearance (including uniform, hair, and name tag),” the others’ evaluation means were higher than the self-evaluation means. T-tests showed a significant difference in “maintains standards of personal appearance (including uniform, hair, and name tag)” (t=-2.103, degrees of freedom [df]=71.104, p<0.05) and “attends to patients with a polite manner” (t=-2.087, df=74, p<0.05) for both the high and low groups. Conclusion: Greeting, appearance, communication skills, and attitude were found to be the important bases of attitude education in the nursing training ideally involving multidisciplinary professionals. The medical students were able to grasp what is required of doctors and objectively view such position from the viewpoints of nurses and patients. [ABSTRACT FROM AUTHOR]

In Montgomery v Lanarkshire Health Board, the Supreme Court declared that patients are entitled to choose among all available treatments. But, who decides what is 'available'? Doctors rely upon evidence-based medicine (EBM) – a complex epistemology that generates normative recommendations – for determining treatment availability. EBM is required to be applied through exercise of the treating doctor's clinical judgement, which inescapably involves some value judgements. EBM attempts to accommodate patient values through shared decision-making (SDM). However, SDM remains contingent upon EBM for its starting points, and this contingency provokes a charge of epistemic injustice because it privileges the treating doctor's judgement over conflicting views. Such a charge was implicit in Montgomery. The Court responded by adopting a strategy that retains reliance on clinical judgement, yet attempts to restrict the treating doctor's privilege by admitting other professional views. This strategy permits the induction of a three-step test for availability of treatment, which is theoretically appealing but challenges the practical organisation of the medical profession. [ABSTRACT FROM AUTHOR]

ObjectivesCalifornia features low smoking prevalence, cautionary electronic cigarette (e-cigarette) public messaging, and legal recreational cannabis: a unique landscape for dental professionals to navigate tobacco cessation promotion. This cross-sectional study assessed California dental professionals' self-reported tobacco patient counseling behaviors and the correlates of providing such assistance.MethodsStatewide surveys of dental hygienists (n = 701) and dentists (n = 725) were distributed electronically. The dentist survey was weighted for sampling and nonresponse. Prevalence of asking patients about use was compared for cigarette and noncigarette products (e.g., e-cigarettes, cannabis). Multivariable models identified independent correlates of providing cessation assistance to tobacco-using patients.ResultsRespondents reported frequently (often/always) documenting patient tobacco use (hygienists: 80%; dentists: 73%) but less commonly provided forms of assistance (hygienists: 27%-49%; dentists: 10%-31%). Most respondents asked patients about cigarette smoking, but noncigarette product use (cigar, hookah, pipe, e-cigarette, or cannabis) was not commonly assessed. Greater confidence and willingness to assist were positively associated with providing assistance in multivariable models, but perceived barriers (e.g., lack of time and remuneration) were not. Results were robust to model specifications.ConclusionsCalifornia dental professionals often ask about smoking but lag in providing cessation assistance and inquiring about noncigarette products. Successful efforts to encourage dental professionals' engagement in tobacco prevention and cessation must enhance providers' self-efficacy and motivation and likely will require system and organizational change.Knowledge transfer statementStudy findings identify substantial gaps in dental professionals' engagement in patient tobacco cessation. The results identify correlates of providing assistance and of dental professionals' willingness and confidence to do so, which could serve to inform interventions to support and enhance engagement.

Abstract Background Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed. Main body Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians’ duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians’ psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause—endangering hospital staff and others. Conclusions Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations’ effects on clinicians, but should do so.

Public health care in Germany, whilst having many advantages, has reportedly strong deficiencies in regards to sustained therapeutic relationships, mostly due to reduced or dysfunctional doctor-patient-communication, which would need to be improved when promoting therapeutical alliance. Communication culture and role modelling between doctors as well as between teachingdoctors and medical students play a critical part in shaping and constituting medical professionalism. To collectively move towards a more patient-centred communication style, it is necessary to address aspects of intra-professional culture that are vital to an empathic attitude. In this paper some of the major concerns with medical professionalism as part of teaching by example will be examined and put into perspective with some prevalent counterproductive practices, such as hierarchical competitiveness, abbreviated conversational habits and problems with hazing in higher education. These will need to be addressed in order to create a more constructive professional environment that is healthy for both patients and medical practitioners. [ABSTRACT FROM AUTHOR]

One of the central themes regarding the reasons why successful doctor-patient-communication and patientcentred care is so difficult to realize in practice is the fundamental asymmetry of needs that shapes the doctorpatient- relationship. The patient as a rule is much more dependent on comprehensible explanations, practical support and general benevolence of the medical team than any healthcare practitioner could ever be on a single patient. Amongst other issues like economical pressure and demographic change, the disparity in dependence is a central theme in the fight for mutual understanding and finding common ground and a constant source of discomfort when it comes to patients' dignity. In this paper some of the major problems that doctors are faced with, as part of their work with patients, will be examined and circumstantial difficulties as part of doctors' role and placement in the context of public health care identified. This can hopefully serve as a conceptual base to give some context to problems that need to be reflected and made progress on in order to improve doctor-patientcommunication. [ABSTRACT FROM AUTHOR]

Abstract Background Although there are many tools to assess medical professionalism, they rarely address patients’ perspectives. The instrument for patient assessment of medical professionalism (IPAMP) comprises 11 items and has been established and validated as a valuable tool for assessing trainees’ professionalism from the patient’s perspective. However, there is no instrument to assess professionalism from the patient’s perspective in Japan. The purpose of the present study was to develop a Japanese version of the IPAMP (J-IPAMP) and test its validity and reliability. Methods We conducted a cross-sectional survey to examine the reliability and validity of the J-IPAMP in two hospitals (one each in an urban and rural area) in Japan. Receptionists or surveyors distributed the anonymous questionnaire to 276 inpatients; all participants were aged above 20 years and assigned to medical trainees. We evaluated its structural and criterion-related validity, as well as internal consistency reliability. Results Data of 235 (85.1%) patients were analyzed. Using the split-half validation technique, we performed an exploratory factor analysis (EFA) along with a confirmatory factor analysis (CFA). The EFA showed a one-factor solution. Then, to compare the model fitness between two models (the two-factor model from the original English version vs. unidimensional model suggested by the EFA), the CFA was performed. The CFA showed that almost all of the fit indices met their respective criteria and were approximately the same for the two models. Thus, we adopted a single-factor model. The Pearson correlation coefficients between the total J-IPAMP scores and the global ratings were 0.738, indicating adequate criterion-related validity. The Cronbach’s alpha of the 11 items of the instrument was 0.96 (95% confidence interval: 0.96–0.97) and the omega value was 0.96, demonstrating acceptable internal consistency reliability. Conclusions We developed the Japanese version of the IPAMP. Its validity and reliability were verified through analysis. This instrument can be utilized for professionalism education in the postgraduate training setting.

Abstract Background A multiplicity of qualities and behaviours are considered essential in a good doctor and are identified in various medical profession frameworks. However, there is no consensus as to their meaning or even agreement on fundamental qualities. The authors wanted to examine the importance placed by the Austrian public on the professional and personal traits of ideal physicians. Competencies were used to create different types of ‘good doctor’ and then examined to discover how these can be integrated into existing medical professionalism frameworks. Methods A 69-item Likert scale-based questionnaire was developed and administered via telephone interview to 1,000 subjects. Computer-assisted telephone interviews (CATI) were carried out by the Austrian GALLUP-Institute. An explorative factor analysis with promax rotation was undertaken to summarise the interrelationships among variables. Results Factor analysis identified six interpretable factors which we define as six different types of doctors: the dutiful doctor, the online health-celebrity, the medical expert, the service physician, the medical altruist, and the ethical agent. The items perceived as most important were ‘takes time’, ‘listens’, and ‘makes correct diagnoses’. Outcome measures of internal consistency and reliability estimates (Cronbach´s alpha, 0.69–0.86) for each element. Conclusions The six types of physicians may be a step toward recognizing the professional behaviour of all physicians, their actions as healers, and their commitment to moral concepts, values, and needs of their patients, and society. According to our results, the public has expectations of good doctors that go beyond the scope within the medical professionalism frameworks. Therefore, these guidelines should be adapted in light of the changing expectations and needs of the general population.

Abstract Introduction Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students’ sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism. Method Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications. Results Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism. Conclusion ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants’ personalities, motivations, and clinical activities requires further investigation.

Copyright of Journal of Health Sciences of Kocaeli University / Kocaeli Üniversitesi Sağlık Bilimleri Dergisi is the property of Institute of Health Sciences of Kocaeli University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Professional identity formation has become a key focus for medical education, but there is still much to learn about how to help students develop their professional identity. At a time when influential concepts such as public- and patient-centered care have become common values, there is little research on the conceptions of the public that trainees might adopt during their training. Defining characteristics of 'good' and 'bad' physicians can be a starting point when considering how to incorporate aspects of professional behavior into medical curricula. Therefore, this study examined the essential elements of physician identity from the public's perspective. This study aimed to describe the Austrian public's viewpoint about the characteristics of 'good' and 'bad' doctors. Using a qualitative research design, interviews were conducted with the Austrian public (n = 1000, mean age 46.4 ± 15.8 years). Interviews were transcribed verbatim and analyzed via qualitative content analysis. The respondents stated 2078 answers for 'good' and 1728 for 'bad' doctors. The content analysis produced seven categories: 'social skills' (36.3%), 'professional competence' (30.2%), 'personality' (10.8%), 'communication' (6.3%), 'practice organization' (5.9%), 'ethical and moral behavior' (5.7%), and 'I do not know, or I have no idea' (4.9%). The public can help medical students to construct their professional identity by supporting the exploration of and commitment to professional values that society expects of physicians. Ideally, fusing medical expertise with social skills will fulfill the ideal of what the public considers a 'good' doctor. This shared definition of a 'good physician' has several implications for medical education. Future physicians can benefit from education about the general population's medical needs as well as personal needs, fears, and concerns. [ABSTRACT FROM AUTHOR]

Introduction: Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students’ sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism. Method: Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications. Results: Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism. Conclusion: ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants’ personalities, motivations, and clinical activities requires further investigation. [ABSTRACT FROM AUTHOR]

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide 'high-value, cost-conscious care' (HVCCC), which proponents believe is the future of sustainable medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors' professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient's quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Medical professionalism is one of the areas of competence in undergraduate and postgraduate medical education. In this study, we aimed to determine the medical professionalism attitudes of third-year medical students and to investigate the effect of gender, reason of preference, and presence of a doctor in the family on these attitudes. METHODS: A cross-sectional study was carried out with 331 third-graders who volunteered. As a data collection tool, the Penn State School of Medicine (PSCOM) professionalism questionnaire-student form and a short sociodemographic information form were used. Data were analyzed using the SPSS 20.0 software (SPSS Inc., Chicago, IL, USA) program. RESULTS: The average age of students was 21.45+-2.0, and 168 (50.8%) were female. Average attitude scores are found as, accountability 30.29 +- 4.19 (7-35), enrichment 24.88 +- 3.78 (6-30), equity 18.26 +- 2.12 (4-20), honor and integrity 36.37 +- 3.87 (8-40), altruism 13.11 +-1.90 (3-15), duty 21.92+-2.80 (5-25), respect 9.05+-1.25 (2-10). Professional attitude scores of female students were higher than men's, students who chose the medical school because it was their ideal and to help people had significantly higher scores than students who preferred it for other reasons (p0.05). DISCUSSION AND CONCLUSION: Third-year medical students have a positive attitude towards professionalism. While gender and medical school preference were effective on these attitudes, the presence of doctors in the family was not found to be effective.

Professional identity formation has become a key focus for medical education, but there is still much to learn about how to help students develop their professional identity. At a time when influential concepts such as public- and patient-centered care have become common values, there is little research on the conceptions of the public that trainees might adopt during their training. Defining characteristics of ‘good’ and ‘bad’ physicians can be a starting point when considering how to incorporate aspects of professional behavior into medical curricula. Therefore, this study examined the essential elements of physician identity from the public’s perspective. This study aimed to describe the Austrian public’s viewpoint about the characteristics of ‘good’ and ‘bad’ doctors. Using a qualitative research design, interviews were conducted with the Austrian public (n = 1000, mean age 46.4 ± 15.8 years). Interviews were transcribed verbatim and analyzed via qualitative content analysis. The respondents stated 2078 answers for ‘good’ and 1728 for ‘bad’ doctors. The content analysis produced seven categories: ‘social skills’ (36.3%), ‘professional competence’ (30.2%), ‘personality’ (10.8%), ‘communication’ (6.3%), ‘practice organization’ (5.9%), ‘ethical and moral behavior’ (5.7%), and ‘I do not know, or I have no idea’ (4.9%). The public can help medical students to construct their professional identity by supporting the exploration of and commitment to professional values that society expects of physicians. Ideally, fusing medical expertise with social skills will fulfill the ideal of what the public considers a ‘good’ doctor. This shared definition of a ‘good physician’ has several implications for medical education. Future physicians can benefit from education about the general population’s medical needs as well as personal needs, fears, and concerns.

Background: Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed.Main Body: Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians' duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians' psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause-endangering hospital staff and others.Conclusions: Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations' effects on clinicians, but should do so. [ABSTRACT FROM AUTHOR]

Objective: The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors., Design: We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods., Setting: Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics., Participants: Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys., Results: Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001)., Conclusions: With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Professionalism and medical ethics, while similar, are often viewed in different contexts. An historical and social science analysis reveals that professionalism is a complex skill that can be developed over time. The key components of professionalism, as defined by the American Physical Therapy Association, include accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility. Throughout history, physicians have been concerned with medical ethics and professionalism. In the Golden Age of Islam, principles such as excellence, honour, integrity, accountability, and duty were important in shaping the professional behavior of physicians. Adab al-Tabib , an ancient work, by Ishāq bin Ali al-Ruhawi focuses on ethical guidelines and teachings related to medical ethics in the Islamic civilization. Many of the ethical issues in this book are of foremost importance as components of professionalism. However while the examples of medical ethics guidelines that pre-existed Adab al-Tabib such as the Hippocratic Oath, are not mentioned. As one of the first statutes of medical ethics in Islamic civilization, Ruhawi is a model for many doctors in the Golden Age of Islam, and over the years his principles have greatly influenced the professional view of physicians., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.