Structuring the Investment Opportunity for a Transition to Practice Program.

Gaining organizational commitment to build or expand a transition to practice program is greatly enhanced by following a business strategy that calls out an encompassing program return on investment (ROI). This article proposes the ROI categories that are powerful investment influencers for executives responsible for funding programs. The business strategy offers insight on how to connect workforce pipeline, retention, program accreditation/reimbursement, traveler replacement, improved quality measures, and career advancement data into a persuasive investment case. Additionally, for advanced practice residency/fellowships, additional categories of linking quality outcomes, billing and revenue generation, productivity, and procedural services are highlighted. [J Contin Educ Nurs. 2022;53(7):293-296.].

Construção de fluxograma e protocolo de enfermagem para manejo da sífilis na atenção primária em saúde / Construcción de flujograma y protocolo de enfermería para el manejo de la sífilis en la atención primaria de salud / Construction of a nursing flowchart and protocol for syphilis management in primary health care

RESUMO Introdução: a sífilis é uma doença facilmente tratável, porém, no Brasil, ainda é um problema de saúde pública. Objetivo: construir um fluxograma e um protocolo para manejo da sífilis em adultos na Atenção Primária à Saúde. Método: pesquisa quanti-qualitativa, desenvolvida em 2019, realizada com 42 enfermeiros da Atenção Primária à Saúde de um município no oeste catarinense. Para a etapa quantitativa aplicou-se um questionário autoaplicado, embasado nos protocolos vigentes do Ministério da Saúde. A etapa qualitativa ocorreu por meio de uma pesquisa participativa do tipo pesquisa-ação com oito dos 42 enfermeiros. Estes, em dois grupos focais, produziram coletivamente um fluxograma e um protocolo de manejo da sífilis em adultos e, posteriormente, após análise do material construído, validaram os documentos, por meio de análise de conteúdo, resultando em 100% de concordância. Resultados: os produtos construídos representam a descrição das melhores práticas profissionais a serem seguidas. O fluxograma apresenta as etapas no manejo, e o protocolo descreve as atividades que envolvem o atendimento relacionado à doença nos adultos atendidos na Atenção Primária à Saúde do município. Considerações finais: a construção do fluxograma e do protocolo atenderam as necessidades dos profissionais da saúde, na qualificação do atendimento às pessoas com sífilis no município.

RESUMEN Introducción: la sífilis es una enfermedad fácilmente tratable, sin embargo, en Brasil, todavía es un problema de salud pública. Objetivo: construir un flujograma y un protocolo para el manejo de la sífilis en adultos en la Atención Primaria de Salud. Método: investigación cuanti-cualitativa, desarrollada en 2019, realizada con 42 enfermeros de la Atención Primaria de Salud de un municipio en el oeste catarinense, Brasil. Para la etapa cuantitativa se aplicó un cuestionario autoaplicado, basado en los protocolos vigentes del Ministerio de Salud. La etapa cualitativa ocurrió por medio de una investigación del tipo acción participativa con ocho de los 42 enfermeros. Estos, en dos grupos focales, produjeron colectivamente un flujograma y un protocolo de manejo de la sífilis en adultos y, posteriormente, tras el análisis del material construido, validaron los documentos, por medio de análisis de contenido, resultando en un 100% de concordancia. Resultados: los productos construidos representan la descripción de las mejores prácticas profesionales a seguir. El flujograma presenta las etapas en el manejo, y el protocolo describe las actividades que involucran la atención relacionada con la enfermedad en los adultos atendidos en la Atención Primaria de Salud del municipio. Consideraciones finales: la construcción del flujograma y del protocolo atendieron las necesidades de los profesionales de la salud, en la calificación de la atención a las personas con sífilis en el municipio.

ABSTRACT Introduction: syphilis is an easily treatable disease, even though it is still a public health problem in Brazil. Objective: to build a flowchart and a protocol for syphilis management in adults in Primary Health Care. Method: quantitative-qualitative study of 42 Primary Health Care nurses from a municipality in western Santa Catarina performed in 2019. In the quantitative stage, a self-administered questionnaire based on the current protocols of the Ministry of Health was applied. The qualitative stage was performed through participatory action research with eight out of 42 nurses. In two focus groups, they collectively produced a flowchart and a protocol for the management of syphilis in adults. After analyzing the constructed material, they validated the documents through content analysis, resulting in 100% agreement. Results: the products built describe the best professional practices to be followed. The flowchart presents the steps in the management, and the protocol describes the activities involving the care related to the disease in adults treated in Primary Health Care of the municipality. Final considerations: the construction of the flowchart and the protocol met the needs of health professionals in the qualification of care for people with syphilis in the municipality.

Professional practice assessment for minor head injury management in emergency department and clinical impact of a simulation-based training: Interventional study (before/after).

BACKGROUND: Minor head injury is a frequent reason for consultation in the emergency department. The use of computed tomography (CT) has increased dramatically in patients' care. Good time management implementation and interpretation are required. To study the level of agreement with recommendations for a minor head injury in emergency department management and the impacts of simulation-based training (SBT) on professional practice changes. METHODS: Evaluation of professional practice for patient care in an emergency department according to the recommendations of the French Emergency Medicine Society (SFMU) established in 2012 before and after an SBT, including theoretical and simulation courses. It was based on the analysis of time to carry out a CT scan. It was also based on analysis of adherence to brain and spine scan indications and to hospitalization criteria. RESULTS: The SBT carried out in the evaluation of the professional practices makes it possible to acquire the notion of urgency to obtain the CT Scan within one hour when the criteria are met (p=0.007). Rater reliability for agreement with the hospitalization recommendations was better after SBT (p=0.03, increased Kappa from 0.73 to 0.93). On the other hand, there appeared to be a lack of essential information in the medical file, such as time of onset of head trauma. CONCLUSION: Management of this type of patient appeared to be satisfactory. It can be improved by SBT on the basis of the SFMU 2012 consensus conference. There is a need to improve the software used by the emergency departments, which should include the time of trauma and recommendations. The association of the clinic and the biomarkers could help to limit the indications of the CT scan, and thus to have it organized more rapidly.

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review.

BACKGROUND: Efforts to improve the quality, safety, and efficiency of health care provision have often focused on changing approaches to the way services are organized and delivered. Continuous quality improvement (CQI), an approach used extensively in industrial and manufacturing sectors, has been used in the health sector. Despite the attention given to CQI, uncertainties remain as to its effectiveness given the complex and diverse nature of health systems. This review assesses the effectiveness of CQI across different health care settings, investigating the importance of different components of the approach. METHODS: We searched 11 electronic databases: MEDLINE, CINAHL, EMBASE, AMED, Academic Search Complete, HMIC, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, LISTA, and NHS EED to February 2019. Also, we searched reference lists of included studies and systematic reviews, as well as checking published protocols for linked papers. We selected randomized controlled trials (RCTs) within health care settings involving teams of health professionals, evaluating the effectiveness of CQI. Comparators included current usual practice or different strategies to manage organizational change. Outcomes were health care professional performance or patient outcomes. Studies were published in English. RESULTS: Twenty-eight RCTs assessed the effectiveness of different approaches to CQI with a non-CQI comparator in various settings, with interventions differing in terms of the approaches used, their duration, meetings held, people involved, and training provided. All RCTs were considered at risk of bias, undermining their results. Findings suggested that the benefits of CQI compared to a non-CQI comparator on clinical process, patient, and other outcomes were limited, with less than half of RCTs showing any effect. Where benefits were evident, it was usually on clinical process measures, with the model used (i.e., Plan-Do-Study-Act, Model of Improvement), the meeting type (i.e., involving leaders discussing implementation) and their frequency (i.e., weekly) having an effect. None considered socio-economic health inequalities. CONCLUSIONS: Current evidence suggests the benefits of CQI in improving health care are uncertain, reflecting both the poor quality of evaluations and the complexities of health services themselves. Further mixed-methods evaluations are needed to understand how the health service can use this proven approach. TRIAL REGISTRATION: Protocol registered on PROSPERO (CRD42018088309).

[What place for French morbidity registries in the era of big data?] / Quelle place pour les registres de morbidité à l'ère des données massives de santé ?

The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of "morbidity registry". In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.

Exploring How the New Entrustable Professional Activity Assessment Tools Affect the Quality of Feedback Given to Medical Oncology Residents.

The post-graduate medical programs at Queen's University transitioned to a competency-based medical education framework on July 1, 2017. In advance of this transition, the Medical Oncology program participated in a pilot of six Entrustable Professional Activities (EPAs) focused workplace-based assessment (WBA) tools with faculty and residents. The purpose of this sequential explanatory mixed method study was to determine the extent to which these WBAs provided quality feedback for residents. The WBAs were introduced into daily clinical practice and, once completed, were collected by the research team. A resident focus group (n = 4) and faculty interviews (n = 5) were also conducted. Focus group and interview data were analyzed using an emergent thematic analysis. Data from the completed assessment tools were analyzed using both descriptive statistics and a literature-informed framework developed to assess the quality of feedback. Six main findings emerged: Verbal feedback is preferred over written; providing both written and verbal feedback is important; effective feedback was seen as timely, specific, and actionable; the process was conceptualized as coaching rather than high stakes; there were logistical concerns about the WBAs, and additional clarification about the WBA tools is needed. This study provides insight into faculty and resident perceptions of quality feedback and the potential for WBA tools to assist in providing effective feedback to residents as we shift to competency-based medical education in Canada. Our results suggest the need for additional faculty development around the use of the tools, and their intended role, and the elements of quality feedback.

Ethics and Industry Interactions: Impact on Specialty Training, Clinical Practice, and Research.

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.

Education and Professional Development in Rheumatology: Translating Quality Improvement and Education to Clinical Practice.

Academic institutions play an essential role in providing physicians with the necessary skills needed to improve the quality and value of care provided. The Accreditation Council for Graduate Medical Education has several milestones in the curriculum of fellowship programs that prioritize involvement in quality improvement (QI) and patient safety efforts. This article reviews the unique benefits and challenges of involving and teaching fellows to conduct QI initiatives. Strategies and resources available to overcome these challenges and develop a successful quality driven training environment are outlined in this article.

Turning Objective Structured Clinical Examinations into Reality.

Objective structured clinical examinations assess learners "showing how" to perform complex clinical tasks. Devised as summative evaluations, these examinations with immediate feedback are useful formative evaluations to improve learner performance. This review describes how objective structured clinical examinations have been used in rheumatology education. Steps for creating an objective structured clinical examination are discussed. Validity and reproducibility are important considerations, especially for high-stakes summative objective structured clinical examinations. Consideration of the potential benefits in clinical education and their hazards are reviewed. When well-designed, formative objective structured clinical examinations have high educational value for learners and medical educators.

Prioritizing Patient Safety Efforts in Office Practice Settings.

OBJECTIVES: Outpatient care settings face unique risks of adverse events and medico-legal liability, often worsened by inconsistent processes and fragmented care. Health systems are increasingly providing integrated care that includes outpatient care, but models of how to systematically target medico-legal risk in office practices are largely absent. Innovative and scalable efforts are needed to guide large health systems in their approach to outpatient safety. METHODS: A malpractice consortium consisting of five large health care delivery systems identified that its ambulatory care cases (including office practices, outpatient hospital settings, and emergency departments) account for 30% to 35% of annual medical malpractice costs, and missed or delayed diagnoses account for approximately 50% of office practice liability risk. To further understand risks and opportunities in office-based practices, a team of patient safety and loss prevention professionals conducted site visits to seven outpatient-affiliated sites of the five health systems from January to March 2016 and interviewed several key informant members of physician, nursing, and administrative leadership. RESULTS: We identified eight common patient safety risk domains based on analysis of eight sets of group interviews. Risk domains were then prioritized by members of the consortium leadership using scoring criteria that we developed based on existing risk assessment and prioritization approaches. The method helped identify communication and follow-up of diagnostic test results in the outpatient setting as the single most important risk area to target improvement efforts. CONCLUSIONS: A targeted approach to identify a single high-risk area led to development of dedicated teams to conduct local patient safety improvement projects at the affiliated health systems and for sharing lessons learned. Similar efforts elsewhere could lead to safety improvements in office practices at other large health systems.

A multicentre assessment of prostate MRI quality and compliance with UK and international standards.

AIM: To assess prostate magnetic resonance imaging (MRI) image quality and compliance with technical standards between centres in the South West region of the UK. MATERIALS AND METHODS: Fifteen imaging sites in the region submitted seven consecutive anonymised MRI studies. These were assessed by two experienced radiologists in consensus. Overall, subjective image quality for T2-weighted imaging (T2W), diffusion weighted imaging (DWI), and dynamic contrast enhancement (DCE) was scored on a five-point Likert scale. Five additional quality parameters were also assessed visually, including image noise, motion, artefact, and distortion. The degree of compliance by each site with 21 published technical standards was also assessed. RESULTS: Ninety-four MRI examinations were reviewed from across all sites (mean 6.3 scans per site, range 5-7). Mean compliance with technical standards was 63% (range 38-86%). Forty-seven percent of sites did not perform DCE. One site used a 3 T scanner. The percentage of patients with overall quality scores of ≥3 (diagnostically acceptable) were 68% for T2W, 81% for DWI, and 60% for both T2W and DWI. Ninety-three percent of the 45 patients who underwent DCE had diagnostically acceptable studies. By scanner age, the percentage of patients with diagnostically acceptable T2W scores was 53% for scanners ≥7 years and 80% when <7 years (p=0.006). Comparing individual sites, the mean overall quality scores were 2.9 (range 2.2-4.2) for T2W, 3.2 (1.8-4.7) for DWI, and 3.4 (2.5-4.7) for DCE. CONCLUSION: There is wide variation in compliance with recognised technical standards and image quality across sites. If MRI is to replace biopsy in selected low-risk patients, improvements in image quality may be required.

Defining advanced practice in radiation therapy: A feasibility assessment of a new healthcare provider role in Ontario, Canada.

INTRODUCTION: This study assesses the feasibility of a new role for radiation therapists in Ontario, Canada, called the Advanced Practice Radiation Therapist (APRT), which would address health service pressures and improve patients' access to care. METHODS: A literature search and expert consensus were used to define advanced practice. A standardized template was used to record each APRTs activities/competencies, along with the requisite knowledge, skills and judgment required to perform these competencies. A thematic analysis of the lists was undertaken to develop a single competency profile. Seven APRTs were deployed at four cancer centres to gather contextual information on the development and integration of the new role. RESULTS: The definition of AP consists of seven key traits and includes a framework identifying stages of practice from entry-level practitioner through expert to advanced practitioner. The competency profile consists of clinical, technical and professional domains which further define the scope of practice and shepherd the role through stages of implementation. Role testing showed support for the role and demonstrated that APRTs can deliver specialized services, perform delegated tasks and their work can lead to program efficiencies and new services. The new role may also lead to improved radiation therapist recruitment rates and work satisfaction. CONCLUSIONS: This feasibility assessment served as the foundation for the future long-term implementation of the Clinical Specialist Radiation Therapist (CSRT) Project. As of 2018, there were 24 CSRTs in Ontario. The APRT role is a natural progression for a readying profession which can play a transformative role in addressing health human resource shortages.

Insegurança nas ações de controle do câncer de colo uterino: atuação do enfermeiro na Estratégia de Saúde da Família / Insecurity in cervical cancer control actions: the nurse's role in the family's health strategy / Inseguridad en las acciones de control del cáncer de cuello uterino: actuación del enfermero en la estrategia de salud de la familia

Objetivo: analisar as ações de controle do câncer de colo uterino (CCU) desenvolvidas pelo enfermeiro na Estratégia de Saúde da Família (ESF) em um município da região sul de Mato Grosso. Métodos: trata-se de uma pesquisa exploratória, descritiva e com abordagem qualitativa, realizada em doze ESFs. A coleta de dados ocorreu no período de maio a junho de 2017, com 12 enfermeiros, por meio de entrevistas semiestruturadas. Para a análise dos dados utilizou-se a Análise de Conteúdo de Bardin. A pesquisa foi aprovada por Comitê de Ética em Pesquisa em 26 de abril de 2017. Resultados: a análise dos dados resultou em duas categorias denominadas: "a insegurança na realização do exame Papanicolaou" e "ações de controle do CCU". Conclusão: podemos concluir que, embora os enfermeiros reconheçam a necessidade e a relevância de rastreamento e diagnóstico precoce, a prática profissional relatada é bem divergente do preconizado pelo Ministério da Saúde. Descritores: Neoplasias do colo do útero, Teste Papanicolaou, Cuidados de Enfermagem

Objective: analyze the control actions of uterine cervix câncer (CCU) developed by Estratégia de Saúde da Família's nurses (ESF) in the municipality south region of Mato Grosso. Methods: This is an exploratory, descriptive and qualitative approach research, realized in twelve ESF's. The data collection was achieve in the period from May to June of 2017, with 12 nurses, through semistructures interviews. To conduct the data analysis was used "Content Actions of Bardin". This research was approved by Comitê de ÉticaemPesquisa in April 26th, 2017. Results: the data Analisis results between two categories called "The insecurities in accomplishment of Papanicolau" and "Control actios of CCU".Conclusion: We can conclude althought the nurses recognize the relevance and needs of the tracking code and early diagnosis, professional practice related is very different and divergent proposed by Ministério da Saúde

Objetivo: analizar lãs acciones de control Del cáncer de cuello uterino (CCU) desarrolladas por el enfermero em la Estrategia de Salud de La Familia (ESF) em el municipio región sur de Mato Grosso. Métodos: se trata de una investigación exploratoria, descriptiva y com abordaje cualitativo, realizada en doce ESF's. La recolección de datos ocurrióen el período de mayo a junio de 2017, con 12 enfermeros, por medio de entrevistas semiestructuradas. Para el análisis de los datos se utilizo el Análisis de Contenido de Bardin. La investigación fue aprobada por el Comité de Ética en Investigación el 26 de abril de 2017. Resultados: el análisis de los datos resultóen dos categorías denominadas: "La inseguridad en la realización del examen Papanicolaou" y "Acciones de Control del CCU". Conclusión: podemos concluir que aunque los enfermeros reconocen la necesidad y relevancia Del rastreo y diagnóstico precoz, la práctica profesional relatada es muy divergente del preconizado por el Ministerio de Salud

The impact of insurance coverage on the prenatal genetic counseling process: An exploration of genetic counselors' experiences with TRICARE.

The prenatal genetic counseling process may be influenced by the patient's insurance coverage for both prenatal testing and termination. Major commercial insurance providers have different policies. TRICARE is the United States Department of Defense health program for uniformed service members. TRICARE provides coverage to approximately 9.4 million beneficiaries, including health plans, special programs, prescriptions, and dental plans. TRICARE's covered medical expenses are outlined in their policies, including those pertaining to genetic testing and termination. This qualitative study aimed to explore the extent to which insurance coverage of prenatal genetic testing and termination of pregnancy affect the genetic counseling process by exploring genetic counselors' experience with TRICARE. The majority of counselors stated that they did not change their overall counseling process for TRICARE patients. However, several counselors expressed that they changed the way they discussed cost with TRICARE patients, specifically in regard to genetic testing. Additionally, counselors provided their perceptions of their patients' emotional experiences. With the recent consolidation of the three TRICARE regions into two TRICARE Regional Office (TRO) regions and the renewal of the Laboratory Developed Tests Demonstration Project, the findings of this study are valuable in the evaluation of TRICARE's coverage of prenatal genetic services.

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology.

BACKGROUND: Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. MATERIALS AND METHODS: We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013-2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association. We used modified Poisson regression to control confounding by other physician characteristics. RESULTS: Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58-2.07), CML (RR 1.22, 95% CI 1.08-1.39), and lung (RR 1.69, 95% CI 1.58-1.82), but not prostate (RR 0.97, 95% CI 0.93-1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict-of-interest policies were not consistently associated with the direction of prescribing change. CONCLUSION: The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing. IMPLICATIONS FOR PRACTICE: Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug.

[Names and indications of antibodies facing regulations and pharmaceutical company practices]. / Dénominations et indications des anticorps face à la réglementation et aux pratiques des laboratoires pharmaceutiques.

The names and therapeutic indications of monoclonal antibodies must comply with current regulations, which does not prevent the development of commercial strategies around trade names. Some of these practices are based on territorial or legal considerations while others are motivated by real medical concerns. Finally, some of these have a significant financial impact on the community.

TITLE: Dénominations et indications des anticorps face à la réglementation et aux pratiques des laboratoires pharmaceutiques. ABSTRACT: Les dénominations et les indications des anticorps monoclonaux thérapeutiques doivent répondre aux réglementations en vigueur, mais s'accompagnent du développement de stratégies commerciales autour des noms commerciaux. Certaines de ces pratiques obéissent à des considérations territoriales ou juridiques, tandis que d'autres sont motivées par de réelles préoccupations médicales. Enfin, certaines ont un impact financier non négligeable pour la collectivité.

Discourses of professionalism: Metaphors, theory and practice.

Professionalism is a contested concept and different discourses have differed by scope and epistemology. The theory of communicative action integrates epistemology (knowledge interests) with that of scope (lifeworld). AIM: To pragmatically inform learning of professionalism. METHODS: apply the theory of communicative action to professionalism discourses. RESULTS: Previous professionalism discourses translated into four frames: technical; communicative; improvement, and critical. These can be viewed as four metaphors the scale; conversation; consensus conference, and protest. The theory of communicative action demonstrated that a critical frame was often lacking from discussions of professionalism and emphasized critiquing the assumptions made, the way power was utilized, and the ends to which actions were directed. Using these frameworks connected discourses on professionalism to other key medical discourses particularly quality improvement, patient centeredness, social justice, and the professional well-being. CONCLUSION: The theory of communicative action adds value by introducing criteria for the evaluation of individual truth claims that expands the discussion beyond accuracy to include sincerity, ethics and coherence; and it emphasizes promoting free speech and the inclusion of diverse views and stakeholders. The theory of communicative action provides a coherent and useful framework for viewing professionalism that integrates with broader discussions about philosophy, truth claims, and post-modern society.