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The concept of professionalism is embedded into all aspects of nursing education and practice yet is rarely critically interrogated in nursing scholarship. This paper describes how professionalism in nursing is based on whiteness. When actualized, this oppressive construct homogenizes individuals' identities to assist nurses in building and wielding power against each other and against patients, and results in dehumanization and disconnection. Foregrounding an ethic of authenticity as a practice of resistance against white professionalism offers an alternative possibility for how nursing could be taught, practiced and theorized. As such a practice must begin with oneself, the authors outline a reflexive process from which to begin this work., (© 2024 The Author(s). Nursing Philosophy published by John Wiley & Sons Ltd.)

Commitment is an important part of professionalism in pharmacy; however, we have no standardized definition. Commitment, like any other relationship between two parties, must be perceived strongly by both parties involved. In the setting of pharmacy residency training, commitment seems relatively easy to define. Current trends posed by Boehmer show that there must be unexplored complexity that remains in this concept under the surface. There is a need to truly identify the motivations of both residency candidates and residency programs during the interview process. Additional research should aim to identify preceptor perceptions of "good" motivations to pursue residency training. There is a paucity of literature on the factors affecting residency decommitment. To begin discerning these factors and their influence, more data should be collected and made available to researchers regarding decommitment at all stages of the match and residency training., Competing Interests: Declaration of competing interest The author declares no relevant conflicts of interest or financial relationships., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation., Methods: A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout)., Results: The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey). The national estimates for mean moral elevation in medical students and physicians are 4.34/5.00 and 4.22/5.00, respectively. In medical students and physicians, high moral elevation was associated with higher empathic compassion (student odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02-1.67; physician OR 1.22, 95% CI 1.23-1.65) and, similarly, generosity. In addition, higher moral elevation in the physician cohort was associated with greater life meaning (OR 2.03, 95% CI 1.25-3.32) and similarly spirituality., Conclusions: In medical students and practicing physicians, self-reported experiences of high moral elevation with physician role models were associated with higher self-reported measures of patient-centered virtues, spirituality, and life meaning. Our Moral Elevation Scale in Medicine demonstrates preliminary promise as a measure to assess environmental precursors needed for virtue development in professional identity formation, but further reliability and validity testing of this measure is needed.

Most arguments about conscientious objections in medicine fail to capture the full scope and complexity of the concept before drawing conclusions about their permissibility in practice. Arguments favoring and disfavoring the accommodation of conscientious objections in practice tend to focus too narrowly on prima facie morally contentious treatments and religious claims of conscience, while further failing to address the possibility of moral perspectives changing over time. In this paper, I argue that standard reasons against permitting conscientious objections in practice-that their permission may result in harm to patients, the idea that medical providers willingly enter into the medical field, and that conscientious objections stand contrary to medical professionalism-do not apply in all cases and that the medical field and health systems in which many physicians now practice should continue to tolerate conscientious objections in practice., (© 2019. Springer Nature B.V.)

Purpose: Trust in and comparability of assessments are essential in clerkships in undergraduate medical education for many reasons, including ensuring competency in clinical skills and application of knowledge important for the transition to residency and throughout students' careers. The authors examined how assessments are used to determine internal medicine (IM) core clerkship grades across U.S. medical schools., Methods: A multisection web-based survey of core IM clerkship directors at 134 U.S. medical schools with membership in the Clerkship Directors in Internal Medicine was conducted in October through November 2018. The survey included a section on assessment practices to characterize current grading scales used, who determines students' final clerkship grades, the nature/type of summative assessments, and how assessments are weighted. Respondents were asked about perceptions of the influence of the National Board of Medical Examiners (NBME) Medicine Subject Examination (MSE) on students' priorities during the clerkship., Results: The response rate was 82.1% (110/134). There was considerable variability in the summative assessments and their weighting in determining final grades. The NBME MSE (91.8%), clinical performance (90.9%), professionalism (70.9%), and written notes (60.0%) were the most commonly used assessments. Clinical performance assessments and the NBME MSE accounted for the largest percentage of the total grade (on average 52.8% and 23.5%, respectively). Eighty-seven percent of respondents were concerned that students' focus on the NBME MSE performance detracted from patient care learning., Conclusions: There was considerable variability in what IM clerkships assessed and how those assessments were translated into grades. The NBME MSE was a major contributor to the final grade despite concerns about the impact on patient care learning. These findings underscore the difficulty in comparing learners across institutions and serve to advance discussions for how to improve accuracy and comparability of grading in the clinical environment., (Copyright © 2020 by the Association of American Medical Colleges.)

Leadership is a core curricular element of PhD programs in nursing. Our PhD faculty began a dialogue about being a leader, a steward of the discipline. We asked ourselves: (a) What expertise do PhD prepared nurse needs to begin to steward the discipline? (b) How do faculty engage PhD nursing students to assume responsibility for stewarding the discipline? Lastly, (c) How do we work with PhD nursing students to create their vision for how their work contributes to stewarding the discipline, from doctoral coursework throughout their career? We support the need for PhD graduates to have the skills to generate knowledge, conserve that which is important, and transform by disseminating new knowledge to a broad audience. Examples of nurses stewarding the discipline when pioneering research, critiquing traditional approaches to inquiry or trends in nursing practice, and developing policy, are highlighted along with examples of how PhD nursing students begin to steward the discipline., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: New challenges in the medical field of the third millennium emphasise the "humanization of medicine" leading to a redefinition of doctors' values, limits and roles. The study aims to assess whether there are different personality dimensions of physicians in relation to their perception of professional values and public expectations., Methods: A questionnaire on the perception of professional values and the opinion on work in the medical field, work relationships and public expectations was administered to 374 doctors attending Continuing Medical Education courses., Results: Two personality dimensions were identified: the first dimension (which we termed "Performance Attainment") is associated preeminently with values of competence, advocacy, confidentiality, spirit of enquiry, integrity, responsibility and commitment; the second dimension (which we called "Personal Involvement") focuses on concern and compassion. The doctors that have more difficulty accepting judgements on their activity are those who think that "Performance attainment" is less important (β = 6.01; p-value = 0.007). Instead, the doctors who believe "public expectation of the health system" is not high enough, tend to think that "Performance Attainment" is more important (β = -6.08; p-value = 0.024). The less importance is given to the values of "Personal Involvement", the less is the doctor's perception of having a leading role in respect to other health professionals (β = -2.37; p-value = 0.018)., Conclusions: Our results demonstrate that there are two different attitudes in terms of recognition and selection of the essential values to better practice the medical profession. Whether the doctors attach more importance to one dimension or the other, they do not differ in our analysis for how they answered the questions about relationships with patients, colleagues or family commitments in the questionnaire, even if they work in different areas. This suggests that in our research there is no single personal attitude that characterizes "a good doctor"., Competing Interests: The authors have declared that no competing interests exist.

The purpose of this study was to examine the perceptions of Black African-born nurses (BABN) with non-native accents regarding their nursing career advancement in the United States. Data were collected using individual interviews. Fifteen nurses originally from three sub-Saharan African countries were included in the study. The findings were reported under six themes: perceived low level of intelligence, not suitable to lead, making fun of/belittling, prejudging without evidence, downgrading, and accent modification. The finding indicated that participants believed that their race and accent influenced their professional nursing opportunities. These results are relevant to BABNs, nurse educators, and healthcare organization leaders. BABNs are capable of participating in nursing leadership and education despite their non-native accent., (© 2020 John Wiley & Sons Ltd.)

Introduction: Nurses continue to struggle to define their role as professionals in the hospital-setting often being represented in media as less competent than other health care providers. Paradoxically, an annual poll of the public consistently identifies nursing as the most trusted profession. This dichotomy of simultaneously being considered incompetent yet holding a high level of trust leads nurses to question their own professional identity. A gap exists in the literature about the professional identity of nurses who work directly with patients in the hospital environment., Methodology: Therefore, the aim of this interpretive phenomenology study was to describe the lived experience of nurses working with patients in the hospital environment and the meaning of this phenomenon as it relates to their professional identity., Results: Four themes were identified: (a) being validated as an expert by providers within the healthcare system; (b) working well as a valued member of a team; (c) advocating for the patient's needs despite opposition; and (d) Valuing human-ness in the patient., Implications: The findings provide a deeper representation of the practice of hospital-based nurses and implications for Anchornurses to be empowered in their workplace., (© 2020 Wiley Periodicals, Inc.)

First, the authors of this column reiterate the need for using nursing theory as a foundation for nursing research and practice. A study underpinned by Johnson's behavioral model is presented as an excellent example of the use of nursing theory to guide research in the care of people with heart failure.

Professionalism is a critical competency for emergency medicine (EM) physicians, and professional behavior affects patient satisfaction. However, the findings of various studies indicate that there are differences in the interpretation of professionalism among EM resident physicians and faculty physicians. Using a cross-sectional survey, we aimed to analyze common challenges to medical professionalism for Japanese EM physicians and survey the extent of professionalism coursework completed during undergraduate medical education. We conducted a multicenter cross-sectional survey of EM resident physicians and faculty physicians at academic conferences and eight teaching hospitals in Japan using the questionnaire by Barry and colleagues. We analyzed the frequency of providing either the best or second-best answers to each scenario as the main outcome measure and compared the frequencies between EM resident physicians and EM faculty physicians. Fisher's exact test and the Wilcoxon rank sum test were used to analyze data. A total of 176 physicians (86 EM resident physicians and 90 EM faculty physicians) completed the survey. The response rate was 92.6%. The most challenging scenario presented to participants dealt with sexual harassment, and only 44.5% chose the best or second-best answers, followed by poor responses to the confidentiality scenario (69.9%). The frequency of either the best or second-best responses to the confidentiality scenario was significantly greater for EM resident physicians than for EM faculty physicians (77.1% versus 62.9%, p = 0.048). More participants in the EM resident physician group completed formal courses in medical professionalism than those in the EM faculty physician group (25.8% versus 5.5%, p < 0.01). Further, EM faculty physicians were less likely than EM resident physicians to provide acceptable responses in terms of confidentiality, and few of both had received professionalism training through school curricula. Continuous professionalism education focused on the prevention of sexual harassment and gender gap is needed for both EM resident physicians and faculty physicians in Japan., Competing Interests: The authors have declared that no competing interests exist.

Background: Little is known about how nursing and other healthcare students develop professional and interprofessional identities., Objectives: This study a) measures changes in students' professional and interprofessional identities between the start and end of a faculty-wide interprofessional first year programme, and b) identifies factors influencing interprofessional identity strength at the end of the programme., Participants: One hundred and eight first year nursing, medicine and allied health students., Methods: A single-group pre-post-test design was used. Students completed an online survey at the start and end of the year-long programme. The survey comprised measures of professional and interprofessional identity, stereotypes, contact and demographics. The same survey was used twice., Results: There was a small decline in professional identity and a large decline in interprofessional identity across the year. Nursing students, the only group involved in clinical practicums, were exempt from the large fall in interprofessional identity. Quality of contact with students from other professions and autostereotypes about own profession were predictors of interprofessional identity strength at the end of the programme, consistent with intergroup contact theory., Conclusions: Introductory interprofessional education programmes should include opportunities for quality contact with students from other professions, and for students to develop a clear understanding of their own profession., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment., Methods: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs., Results: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions., Conclusions: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies., Competing Interests: The authors have declared that no competing interests exist.

Objectives: to identify the knowledge of nursing professionals about leadership models and evaluate the authentic leadership profile among them., Methods: analytical study, conducted between August and December 2015, involving 84 nursing professionals working in a public and tertiary hospital. We used two instruments: Sociodemographic Questionnaire with questions about leadership and the Authentic Leadership Questionnaire., Results: both nurses and nursing technicians were unaware of authentic leadership. Both pointed to communication, planning, and organization as competencies of the leader (n = 58, 95%). Regarding the authentic leadership profile, we observed that the score was "high" among nurses and "low" among technicians. Holding a leadership position and professionally upgrading has positively influenced the highest-profile of authentic leadership., Conclusions: nurses demonstrated to know behavioral leadership, while nursing technicians showed knowledge about situational leadership. Nurses had a high score of authentic leadership behaviors, while nursing technicians had a low score, but we found no significant difference between them. Holding a leadership position and professionally upgrading has positively influenced the highest profile of authentic leadership.

Objectives: to analyze nurses' professional militancy in the institutionality field, presented by the printed media from Bahia State in the 1970s and 1980s., Methods: a historical and qualitative research under Social History's perspective, whose data source was the newspaper A Tarde. The temporal cut-off encompasses milestones such as professional body restructuring and creation., Results: the Associação Brasileira de Enfermagem democratization movement was reported in a superficial way, highlighting the struggle for power spaces. With respect to Conselhos Federal e Regional de Enfermagem daBahia, the newspaper notified creation and function of bodies, however, there was no visibility to the newspaper's performance. Concerning the union, there was political fragility of nurses against the creation and union participation in the fight for labor rights. Final Considerations: organization of political action occurred from isolated groups mobilization of professionals who were already traveling in political spaces, not the large mass of professionals.

Aim: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators., Design: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian., Methods: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018., Results: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes., Conclusion: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization., Impact: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools., (© 2019 John Wiley & Sons Ltd.)

At the end of the 19th and beginning of the 20th century, a process of modernization, bureaucratization and professionalization of the Argentine Army was initiated. As a result of this process, Army divisions were formed, which are autonomous military organizations composed of units of various weapons, combat support elements and services. Included among the latter was the military health service, which acted both in the operational units of the military districts in order to incorporate citizens into the Compulsory Military Service as well as in military hospitals. This article aims to: 1) characterize this process in relation to the concepts of defense, organization, functions and territorial deployment of the Army; 2) analyze, within that framework, the formation of the military health service between 1888 -when the Organic Law of the Sanitary Corp of the Army and the Navy was sanctioned - and 1938 - when the Army's organic design was changed on the eve of the Second World War.

Lapses in professionalism are a common cause of disciplinary action against physicians by U.S. medical boards. However, the exact definition of "professionalism" is unclear, making it likely that a physician will not train or practice under the same framing of professionalism and so may fail to develop certain skills. The goal of this study was to identify and compare the professionalism framings of medical boards. The medical board web pages for all 50 states, the District of Columbia, and four territories were examined in June 2017 for use of the word "professionalism" or "professional" in their application, rules, or laws, which was then coded as a best fit to one of six core framings of professionalism. Of the 55 states and territories, integrity was the most common professionalism framing (40.0%), followed by excellence (23.6%), behavior (12.7%), mixed (9.1%), unclear (9.1%), and absent (5.5%). Although integrity was the most common framing, diversity exists among medical boards, which could lead to board misunderstandings of incidents labeled as professionalism violations and ineffective remediation of offenses. In order to best communicate the nature of the offense and thus best facilitate remediation, the incident should be called by its true name rather than the all-encompassing term "professionalism."

Changes in how campuses respond to sexual assault under Title IX may dramatically alter the experiences of survivors and the roles of responders. This exploratory study examines how the roles of campus-based sexual assault victim advocates are changing and the effects on advocacy and survivors. Although most advocates agree that Title IX has increased awareness and reporting of sexual assault, they are concerned about the loss of confidential outlets for reporting, conflicts with other responders, and devaluation of their role. Some advocates see professionalization as a solution, whereas others worry that professionalization might negatively affect their ability to serve survivors.

Background: In 2009, an International Working Group (IWG) on the Assessment of Professionalism began collaborating and published recommendations in 2011. Nearly a decade later the IWG reconvened to take stock of the state of practice and research in professionalism and the impact of the 2011 report., Method: A bibliometric study identified all publications on assessment of professionalism since 2011, noting those that cited the original report. Articles were coded to identify the reason for citation and new trends in assessment. Bibliometric data were supplemented by discussion groups held at key international education meetings., Results: Six-hundred publications on the assessment of professionalism were found in Google Scholar and 164 in Web of Science since 2011, of which 177 (30%) and 84 (50%) respectively cited the original IWG publication. English language publications were most common (83%), but there were articles in 13 other languages by authors from 40 countries. The report was cited commonly to justify attention to professionalism in general (41%), assessment of professionalism (38%) and to explore professionalism in different countries and professions (25%). A thematic analysis showed that of 9 research areas recommended in 2011, 7 of 9 categories were represented with a large increase in research across languages and cultures., Conclusions: Though the assessment of professionalism remains a challenge the research base continues to grow, especially related to professionalism across cultures and languages, and a large percentage of publications cite the IWG recommendations. There remains a gap in research and writing about patients' perspectives.

Although therapeutic jurisprudence ("TJ") is increasingly well-established internationally, particularly within the United States of America ("US"), to date it remains relatively unacknowledged within the United Kingdom ("UK"). This article will explore the opportunities presented within contemporary UK society for the greater promotion, and eventual mainstreaming, of TJ. It will also consider the challenges faced during this process and how best to overcome these. Its first key area of focus will be upon the potential role of legal education in the UK in educating law students (and academics) about TJ, considering which approaches are likely to be most effective in incorporating TJ perspectives, at what stage this should occur and to what extent TJ is likely to impact on the existing curricula at a time when proposed changes relating to entry into the legal profession are heavily influencing the work of Law Schools. The article will then move on to consider the receptiveness of the UK legal profession to the TJ paradigm in light of recent attempts to move to a competency-based approach to practice and to reconceptualise professionalism to meet the challenges of increasing fragmentation and corporatisation. The third key area it will explore is the UK's recent plans to reintroduce problem-solving courts ("PSCs") into its criminal justice system. The authors will discuss the downfall of the six UK Drug Court ("DC") pilots originally established in 2005 theorising upon their failures and reflecting upon whether the current UK criminal justice system is truly able to support a fresh round of PSC initiatives. The article will end with recommendations for ways in which the international TJ community should begin the process of mainstreaming TJ within the UK. It will conclude that there are currently significant opportunities to be utilised, but that this requires significant commitment and mobilisation amongst existing TJ scholars and practitioners., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Since 2017, students applying to emergency medicine residencies must take the AAMC Standardized Video Interview (SVI) to assess their knowledge of professional behaviors and interpersonal and communication skills. Due to the SVI's novelty, there are not many study tools available to prepare for it, outside of the resources provided by the AAMC., Methods: The SVI Self-Study Guide is a PowerPoint document that learners can use to prepare for the SVI independently. It is intended for fourth-year medical students who are applying to emergency medicine residencies and therefore planning to take the SVI. The guide was distributed via email and assessed with a pre- and postquiz measuring subjective feelings of preparedness as well as testing knowledge of professionalism and interpersonal and communication skills., Results: Eleven students were invited to use the SVI Self-Study Guide, of whom 10 and eight took the pre- and postquiz, respectively. There was a statistically significant increase in learners' self-rated feelings of preparedness to take the SVI ( p < .05). Although there was no significant change in the average score on four knowledge-based questions ( p = .29), the average score increased from 72.50% to 93.25%., Discussion: Overall, there was a higher improvement in feelings of preparedness to take the SVI than in performance on knowledge-based questions. This suggests that learners benefited the most from practicing using the SVI testing format. The SVI Self-Study Guide can be distributed via email to supplement existing resources in preparing for the SVI., Competing Interests: None to report.

Aim: To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre., Background: Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes., Methods: A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours., Results: The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ 2  = 5.65, p < 0.017), observation of LA and VA (χ 2  = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ 2  = 9.03, p < 0.003) were identified., Conclusions: Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression., Implications for Nursing Management: Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required., (© 2018 John Wiley & Sons Ltd.)

Objective: to assess the contribution of the introduction and implementation of the Nursing Process of the University Hospital of the Federal University of Santa Catarina (Universidade Federal de Santa Catarina - UFSC) for the progress of the profession from 1979 to 2004., Method: qualitative and social-historical study. We used oral and documentary sources for data collection, through semi-structured interviews with 14 nurses and documentary analysis. The study was analyzed under Eliot Freidson theory of content and theoretical reference, on the sociology of professions., Results: the challenges mentioned were lack of knowledge; nurses overloaded with responsibilities; precarious physical space and materials; lack of consideration of the Nursing Process by the multiprofessional team. The political participation of the professors of the Nursing Department was fundamental for the successful introduction of the Nursing Process. We emphasize the professional commitment of nurses to face the challenges presented., Conclusion: the introduction and implementation of the Nursing Process contributed to the progress of nursing in the state of Santa Catarina regarding appreciation and professionalization.

In this Invited Commentary, the author examines two curated Academic Medicine volumes showcasing foundational research and key writings on professionalism in medicine and medical education, collectively spanning from 1994 to 2016. The author reviews the beginnings of the medical professionalism movement and examines how the trends and themes reflected in the first volume-specifically the work to define, assess, and institutionalize professionalism-capture key elements in this movement. He then examines how the trends and themes in the second volume align with and build on those from the first, noting two themes that extend across a number of second volume articles: a unit-of-analysis issue and the challenge of context. The author identifies several topics that have yet to be adequately mined and calls attention to two bridge-spanning articles in the second volume that, respectively, take us into the future (around the topic of identify formation) and back to the past (on the hidden curriculum). Finally, the author reflects on "directions home" in medicine's noble search for its moral core and collective identity.

Introduction: Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior., Methods: In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach., Results: Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning., Discussion: Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.

Mentorship has been repeatedly shown to be a necessary component of successful professional development. However, effective mentorship can be elusive to define insofar as "you know it when you have it," but it is hard to match the objective qualities of mentorship with the subjective experience of effective and helpful mentoring. This article explores the Collaborative Family Healthcare Association's mentorship program from the perspective of one mentor and two mentees over the course of a yearlong formal relationship. During the year, both mentees had to navigate significant transitions, including changing jobs and having a baby; these experiences are relevant for many new career professionals. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objective. To design and implement a longitudinal course series focused on professional development and professional identity formation in pharmacy students at Western New England University. Methods. A four-year, theme-based course series was designed to sequentially and longitudinally impart the values, attributes, and characteristics of a professional pharmacist. Requirements of the course include: goal planning and reflective assignments, submission of "Best Works," attendance at professional meetings, completion of service hours, annual completion of a Pharmacy Professionalism Instrument, attendance at Dean's Seminar, participation in roundtable discussions, and maintenance of an electronic portfolio. Though the Professional Development course series carries no credit, these courses are progression requirements and students are assessed on a pass/fail basis. Results. Course pass rates in the 2015-2016 academic year for all four classes were 99% to 100%, suggesting the majority of students take professional development seriously and are achieving the intended outcomes of the courses. Conclusion. A professional development course series was designed and implemented in the new Doctor of Pharmacy program at Western New England University to enhance the professional identity formation of students.

The aim of this study is to explore arguments that broaden the understanding of possible links between the organization of nursing care and the structuring of professional identity. For that purpose, some aspects related to these themes are addressed, highlighting issues regarding differences in the concepts of the organization of nursing care and the nursing process, as well as the performance of this activity and its possible impact on the establishment of its relationship with the professional identity. Emphasis is given to the need to stimulate the debate on the subject by nursing professionals involved in the training of human resources and the provision of care, as well as in class entities, in order to deepen understanding of these concepts as significant elements for strengthening our professional identity.

Purpose: Rehabilitation nurses have essential responsibility for detailed Functional Independence Measure (FIM) documentation and accurate scoring. The goal of this performance improvement project was to improve individual FIM accuracy and establish and maintain a FIM accuracy standard., Design: Case Study., Methods: This performance improvement project was implemented in a 20-bed CARF-accredited Midwestern acute care hospital inpatient rehabilitation unit., Findings: Improved individual and overall RN FIM scoring accuracy, with increased length of stay and case mix index., Conclusions: Concurrent FIM scoring and documentation review holds staff accountable and allows for timely revisions following discrepancy identification. Leadership supports for concurrent FIM audits, utilization of available technology, transparent reporting of results, and individual accountability lead to sustained improvement in FIM scoring accuracy., Clinical Relevance: Accurate FIM documentation and scoring drive appropriate length of stay and case mix group assignment. Assessment competence enhances nursing engagement, confidence, and process accountability.

Monetary fine proceedings has been one of the methods of upholding professionalism amongst health care professionals. Professionalism as a concept is multifaceted and fragmented and it has become symbolic to the extent that, unfortunately, some traits of professionalism showcase the whole concept. It seems fair to interpret the symbolic views on the concept of professionalism as means to capitalize on certain aspects of professions such as commercial profitability for the employer and respected status for the profession. Evaluation of professionalism is often implicit and inadequate; and assessing professionalism by relying on abstract and idealized definitions implies that professionalism is a compounded composite of certain set of stable traits. We suggest to refer to the theory of values-based practice so as to achieve collocated views on professionalism among employers and health academics. Instead of capitalizing on certain traits of professionalism to project the whole concept of professionalism, we may need to relook at the traits of professionalism as values. It is extremely crucial to internalize the values of the health profession in the future health professionals, so that the future health professionals imbibe the professionalism through dialog and democratic methods of sharing values during the course of professional development., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Current controversies in medical education associated with professionalism, including disagreements about curriculum, pedagogy, and assessment, are rooted in part in the differing frameworks that are used to address professionalism. Three dominant frameworks, which have evolved in the medical education community, are described. The oldest framework is virtue based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character. The second framework is behavior based, which emphasizes milestones, competencies, and measurement of observable behaviors: The good physician is a person who consistently demonstrates competence in performing patient care tasks. The third framework is identity formation, with a focus on identity development and socialization into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant with the physician community and aspires to a professional identity reflected in the very best physicians. Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. In this article, the assumptions and contributions of each framework are described to provide greater insight into the nature of professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course., (Copyright 2016 The Journal of Clinical Ethics. All rights reserved.)

Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context., Main Text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes., Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures.

Background: Involving doctors in management has been intended as one of the strategies to spread organizational principles in healthcare settings. However, professionals often resist taking on relevant managerial responsibility, and the question concerning by which means to engage doctors in management in a manner that best fit the challenges encountered by different health systems remains open to debate., Methods: This paper analyzes the different forms of medical management experienced over time in the Italian NHS, a relevant "lab" to study the evolution of the involvement of doctors in management, and provides a framework for disentangling different dimensions of medical management., Results: We show how new means to engage frontline professionals in management spread, without deliberate planning, as a consequence of the innovations in service provision that are introduced to respond to the changes in the healthcare sector., Conclusions: This trend is promising because such means of performing medical management appear to be more easily compatible with professional logics; therefore, this could facilitate the engagement of a large proportion of professionals rather than the currently limited number of doctors who are "forced" or willing to take formal management roles.

Background: China adopted a Flexnerian model as its medical institutions developed over the recent past but the political, social, and economic environment has changed significantly since then. This has generated the need for educational reform, which in other countries, has largely been driven by competencies-oriented models such as those developed in Canada, and the United States. Our study sought to establish the competencies model, relevant to China, which will support educational reform efforts., Methods: Data was collected using a cross-sectional survey of 1776 doctors from seven provinces in China. The surveys were translated and adapted from the Occupational Information Network General Work Activity questionnaire (O*NET-GWA) and Work Style questionnaire (O*NET-WS) developed under the auspices of the US Department of Labor. Exploratory factor analysis and confirmatory factor analysis ascertained the latent dimensions of the questionnaires, as well as the factor structures of the competencies model for the Chinese doctors., Results: In exploratory factor analysis, the questionnaires were able to account for 64.25 % of total variance. All responses had high internal consistency and reliability. In confirmatory factor analysis, the loadings of six constructs were between 0.53 ~ 0.89 and were significant, Construct reliability (CR) were between 0.79 ~ 0.93 respectively. The results showed good convergent validity. The resultant models fit the data well (GFI was 0.92, RMSEA was 0.07) and the six-factor competencies framework for Chinese doctors emerged., Conclusions: The Chinese doctors' competencies framework includes six elements: (a) technical procedural skills; (b) diagnosis and management; (c) teamwork and administration; (d) communication; (e) professional behavior; and (f) professional values. These findings are relevant to China, consistent with its current situation, and similar to those developed in other countries.

Background: Accrediting bodies now recognize the importance of developing the professionalism competency, by setting standards that require medical schools to identify where professionalism is addressed and how it is evaluated within the formal curriculum. The objective of this study was to compare how professionalism competency is formally addressed in the curricula of Canadian medical schools, and to better understand the Canadian approach to reporting and remediation of lapses., Methods: A literature review was performed and with the input of the AFMC(Association of Faculties of Medicine of Canada) Professionalism group, questionnaires were generated. An electronic survey was circulated to key leaders across the country at all the medical schools. In-depth telephone interviews were used to further explore themes, and a subsequent focus group was held to discuss challenges, particularly related to reporting and remediation., Results: The preponderance of formal professionalism teaching remains in the form of lectures and small group sessions in the preclinical years. Formal teaching declines significantly in the clerkship/clinical years. Evaluation is usually performed by a clinical supervisor, but OSCE, portfolio, and concern notes are increasingly used. Role modeling is heavily relied upon in clinical years, suggesting faculty training can help ensure clinical teachers recognize their influence on trainees. Formal remediation strategies are in place at most schools, and often involve essay writing, reflection exercises, or completion of learning modules about professionalism. Lack of clarity on what defines a lapse and fear of reprisal (for both trainees and faculty) limits reporting., Conclusions: This study provides an overview of how professional identity formation is supported in the Canadian context, guided by the standards set out by CanMEDS. Despite a rich literature that describes the definition, program design and evaluation methods for professionalism, in some areas of the curriculum there is still an opportunity to ensure programs embrace the suggested framework. Examples of teaching and evaluation methods, deficiencies in the clinical years of study (clerkship) and challenges in addressing lapses and organizational structure are identified. The results help identify the gaps that need to be addressed and some solutions that can be modeled at other academic institutions.

The widespread use of digital media (both computing devices and the services they access) has blurred the boundaries between our personal and professional lives. Contemporary students are the last to remember a time before the widespread use of the Internet and they will be the first to practice in a largely e-health environment. This article explores concepts of digital professionalism and their place in contemporary medical education, and proposes a series of principles of digital professionalism to guide teaching, learning and practice in the healthcare professions. Despite the many risks and fears surrounding their use, digital media are not an intrinsic threat to medical professionalism. Professionals should maintain the capacity for deliberate, ethical, and accountable practice when using digital media. The authors describe a digital professionalism framework structured around concepts of proficiency, reputation, and responsibility. Digital professionalism can be integrated into medical education using strategies based on awareness, alignment, assessment, and accountability. These principles of digital professionalism provide a way for medical students and medical practitioners to embrace the positive aspects of digital media use while being mindful and deliberate in its use to avoid or minimize any negative consequences.