The Role of Religious Culture in Medical Professionalism in a Muslim Arab Society.

Purpose: Calls have been made to integrate concepts and practices derived from Muslim culture into medical professionalism in Muslim societies. Little is known about how these religious cultural concepts (RCCs) influence medical practice and education. This study explored the influence of RCCs on medical professionalism in Saudi Arabia. Methods: This was a qualitative study that implemented a constructivist, grounded theory approach. Semi-structured interviews about RCCs and medical professionalism were conducted with 15 Saudi physicians at a single academic medical center. Purposive sampling was used to recruit participants of different genders, generations, and specialties. Data collection and analysis were iterative. A theoretical framework was formulated. Results: Key findings: (i) the role of RCCs in medical professionalism is perceived to be constantly evolving due to the evolution of societal interpretations of RCCs; (ii) participants described applying two standards to judge what is professional: a medical standard and a religious cultural standard. Participants shifted between these two standards variably and non-linearly. This variable shifting altered the values shaping medical professionalism, at times unpredictably. Discussion: Academic Saudi physicians argued against assuming a stable traditional interpretation of RCCs, emphasized the evolving contribution of RCCs to medical professionalism, and indicated that the process of merging religious cultural and medical standards in medical practice is variable and may alter medical practice values. Therefore, these physicians perceived RCCs to be useful as supplements to but not as a backbone for medical professionalism. Careful consideration of the potential impact of RCCs on the values of medical professionalism is warranted.

Are the standards of professionalism expected in dentistry justified? Views of dental professionals and the public.

Introduction In the UK, the General Dental Council specifies nine principles of professional standards that dental registrants must follow. There are views that such standards are high, patients' expectations are rising, and the professionalism of dental professionals is increasingly scrutinised. This paper explores whether the high standards expected in dentistry are justified.Methods We applied thematic analysis to 772 free-text responses from dental team members and the public to a modified Delphi survey. Respondents described their views of professional and unprofessional behaviours in dentistry. Data were obtained as part of a larger review of professionalism in dentistry.Results Two lines of argument were identified: professionalism standards are high, but justifiably so; and professionalism standards are too high. Within these, four broad themes emerged: patient trust; comparison with other professions; a culture of fear; and perfection.Conclusion High professionalism standards are justified in a profession where patient trust is paramount. However, a problem lies in the culture that surrounds professionalism in terms of litigation and dental professionals feel pressure to possess an unattainable, infallible nature. These negative impacts need minimising. We suggest that undergraduates and continuing professional development approach professionalism with care, to foster a supportive, positive and reflective culture of professionalism.

Effects of External Employment Opportunities, Nursing Professionalism, and Nursing Work Environments on Korean Hospital Nurses' Intent to Stay or Leave.

This study aims to explore Korean Hospital nurses' intent to stay or leave their working environment, and to identify the difference between the intent to stay and the intent to leave by identifying the relationship between external employment opportunities, professionalism, and work environment. Data were collected via an online survey and analyzed using stepwise multiple regression analysis. As a result of the analysis, the intent to stay among Korean hospital nurses was influenced by the work environment, external employment opportunities, education level, and marital status, whereas the intent to leave was influenced by the nursing work environment, marital status, and total clinical experience. As a result, the reflected variables differed. Thus, it can be concluded that hospital nurses' intent to either stay or leave are not concepts that simply contradict each other in the same context but are, in fact, influenced differently by various factors. Nevertheless, it can also be concluded that nursing managers should make efforts to improve the nursing work environment to lower nurses' intent to leave and increase their intent to stay by improving only the nursing work environment.

Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial.

BACKGROUND: Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students. METHODS: This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention. RESULTS: The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group. CONCLUSION: The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.

A scoping review on the relationship between mental wellbeing and medical professionalism.

BACKGROUND: Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education. METHODS: We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants. RESULTS: From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification. CONCLUSION: The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.

Validity and reliability of the Professionalism Assessment Scale in Turkish medical students.

Medical professionalism is a basic competency in medical education. This study aimed to adapt the Professionalism Assessment Scale, which is used to evaluate the professionalism attitudes of medical students, into Turkish and to assess its validity and reliability. First, the scale's translation-back-translation was performed and piloted on 30 students. Then, the final scale was applied to medical students to ensure the scale's validity. The Penn State University College of Medicine Professionalism Questionnaire was used for external validation to assess criterion validity. Confirmatory factor analysis was performed for structure validity. Test-retest, item correlations, split-half analysis, and Cronbach's alpha coefficient were evaluated to determine the scale's reliability. SPSS 25.0 and AMOS 24.0 package programs were used for statistical analysis. The statistical significance level was accepted as P<0.05. The mean age of the participants was 21±2 years, and 50.5% (n = 166) were female. Three hundred thirty-five students were invited, and 329 participated in the study. The response rate was 98%. The mean total Professionalism Assessment Scale score was 96.36±12.04. The three-factor structure of the scale, "empathy and humanism," "professional relationship and development," and "responsibility," was confirmed. The Cronbach's alpha coefficient of the scale was 0.94, and both the Spearman-Brown and Guttman split-half coefficients were 0.89. The three-factor structure of the scale, consisting of 22 items, explained 59.1% of the total variance. The intraclass correlation coefficient between test-retest measurements was 0.81. Confirmatory factor analysis showed a model suitable for the original version of the scale (χ2/sd = 2.814, RMSEA = 0.074). The Turkish version of the Professionalism Assessment Scale is a valid and reliable tool to determine the professionalism attitudes of medical students in Turkey.

Mitigating Misogynoir: Inclusive Professionalism as a Health Equity Strategy.

As Obstetrics and Gynecology begins to recognize how structural racism drives inequitable health outcomes, it must also acknowledge the effects of structural racism on its workforce and culture. Black physicians comprise ~5% of the United States physician population. Unique adversities affect Black women physicians, particularly during residency training, and contribute to the lack of equitable workforce representation. Eliminating racialized inequities in clinical care requires addressing these concerns. By applying historical context to present-day realities and harms experienced by Black women (ie, misogynoir), Obstetrics and Gynecology can identify interventions, such as equity-focused recruitment and retention strategies, that transform the profession.

Health care professionals' perceptions of unprofessional behaviour in the clinical workplace.

BACKGROUND: Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. OBJECTIVE: To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. METHODS: Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. RESULTS: Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). CONCLUSIONS: Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.

Social Media and Neurosurgery: Insights from the Top 100 Neurosurgery Influencers on Twitter.

BACKGROUND: The rise in popularity of social media (SoMe) in medicine has created a powerful tool for the professional development and continued education of clinicians. Numerous benefits of SoMe exist; however, significant challenges concerning professionalism, confidentiality, and spread of misinformation may limit its usefulness. To understand the ways the top 100 Twitter influencers interact with SoMe, their views on SoMe, and its future in the medical field. METHODS: Literature was reviewed to obtain common concerns about SoMe in the medical field. A survey with 30 questions was sent to the top 100 Twitter influencers in the Neurosurgical field identified by Riccio et al. The survey assessed participant demographics, SoMe activity, stance toward SoMe, and views on the future of SoMe. RESULTS: Most participants were in the age group of 35-44 years (n = 23, 44.2%), resided in the United States (n = 39, 73.6%), have been in practice for 6-10 years (n = 14, 26.4%), and ranked Twitter as the mostly used platform (n = 37,72.6%). Per participant Reponses, 35 (66%) participants have taken a political stance on SoMe, 0 (0%) have gotten into any legal issues regarding a post shared on SoMe, 45 (84.9%) agreed/strongly agreed that SoMe is essential for networking and mentorship, and 49 (92.3%) agreed/strongly agreed that that SoMe will continue to play a major role in the medical field. CONCLUSIONS: Although SoMe has its advantages, several disadvantages render it a double-edged sword. Maximizing SoMe's benefits and minimizing its misuse will further strengthen its role in the medical field.

Addressing the ACGME Competency of Communicating with the Public through the Use of TEDx Talks.

OBJECTIVES: Competency-based public communication skills are not systematically taught in most medical curricula, reflecting a gap between medical knowledge and holistic patient care as trainees transition into clinicians. We sought to investigate the efficacy of technology, entertainment, and design (TED) talks in postgraduate year (PGY) training programs. METHODS: The authors organized an official internal TEDx event in which six PGY trainees volunteered as speakers. Two experienced physicians and two administrators also participated as speakers to provide trainees a didactic shadow learning experience. The remaining PGY trainees, along with clerks, physicians, nurses, pharmacists, and administrators, attended the conference. Before the event, speakers undertook individual training sessions and learned the principles of the presentation structure and storytelling mode. At the end of the event, a survey evaluating overall satisfaction in communication skills and professionalism was administered to all of the attendees. RESULTS: Survey participants totaled 104, with a response rate of 97.2%. TEDx talks improved trainees' levels of patient care, communication, and professionalism. Speakers reported the high level of satisfaction with the event (mean 4.96 on a 5-point Likert scale; standard deviation 0.20). Participants agreed that the shadowing experience was useful and that the event encouraged them to pursue interests outside the medical field. CONCLUSIONS: This study highlights that TED is successful in terms of participant satisfaction and training in communication and professionalism. Engaging and training PGY trainees through TED-style events could bridge the gap between acquired knowledge and professional competencies. The authors recommend the implementation of TED-style events in medical training programs.

Professionalism among Nurses Working at Different Government and Private Hospitals of Province 1.

BACKGROUND: Professionalism is the conceptualization of attributes, interactions, obligations, attitudes, and behaviours required of professionals in relation to clients and society. The objectives of the study were to identify the five specific attitudes of professionalism; belief in self-model, belief in public service, a sense of calling to the field of study, a feeling of autonomy, and the importance of professional organization and to examine the relationship of selected variables with the attributes of professionalism. METHODS: The cross-sectional study design was used. The self-administered questionnaire consisted of Hall's Professional Inventory as revised by Snizek was used for data collection, which includes 25 items. The sample size was 316 nurses from seven government and four private hospitals of province 1. Descriptive statistics were used to find frequencies, percentages, means, SDs, and ranges. Multivariate analysis was performed using a linear regression model. RESULTS: The mean score of the total professionalism was 87.54 (SD=7.99) and the highest score was on attitude towards the sense of calling (Mean=18.86, SD=2.66). Nurses with master's degree education had the high autonomy (ß=-0.193, p=0.004), Matron (ß=2.109, p=0.036) and the membership of Nursing Association of Nepal (ß=0.200, p=0.004), current salary of the senior nurse (ß=-0.172, p=0.037), and matron (ß=-2.501, p=0.013) had a positive relationship with self-regulation. The experienced nurses (ß=-0.296, p=0.010) had a more positive attitude towards a sense of calling. CONCLUSIONS: The professionalism status of nurses was not seen adequate in this study. The present study concluded that the Master's degree in Nursing education, administrative position such as matron, incharge, good salary, sufficient working experience, membership in a professional organization, adequate training, job satisfaction, research and publication are the most important factors of professionalism for nurses.

The Localization, development and validation of a survey instrument to assess attitudes toward professionalism based on the opinions of clinical teachers.

BACKGROUND: This study examined the validation of a survey instrument to assess attitudes toward professionalism based on the opinions of clinical teachers in Iran and localized it. METHODS: The research is applied-descriptive, that is conducted in two stages: qualitative and quantitative. Fifteen expert professors in the field of professionalism from Iranian universities of medical sciences participated in qualitative stage by Delphi. sampling method was purposive. In the quantitative stage, using simple and quota sampling method, 82 samples were collected from all clinical professors of first ranked universities of medical sciences. We used "The Penn State College of Medicine Professionalism Questionnaire"( PSCOM) as a basic questionnaire. Its validity assessed by Delphi and survey. Some items changed, deleted and added. Then it confirmed by confirmatory factor analysis. Data analysis was performed using one-sample t-test and SmartPLS software. RESULTS: Seven dimensions and 48 final indicators were approved and all 7 dimensions were in good condition. Among the approved dimensions, "the enrichment" with a factor load of 0.238, was the biggest factor in measuring the variable of professionalism. The dimensions of "respect", "responsibility", "altruism", "duty", "honor, honesty and justice", "respectively" with factor loads of 0.215, 0.212, 0.163, 0.146, 0.106 and 0.047 are ranked in order. CONCLUSION: the most dimensions in PSCOM are accepted by experts and teachers, but there are many differences in details. If we want to have an accurate tool for measuring attitudes toward professionalism, then, it is necessary to study localization and validation of instrument to assess attitudes toward professionalism in every new community. Delphi and factor analysis could be useful for assessing tool in new community.

Obligation or getaway? A qualitative inquiry into medical professionalism under COVID-19 among medical students and new physicians in a Taiwan hospital.

OBJECTIVES: During the COVID-19 outbreak, medical educators' main concern has been how to prepare new physicians and medical students to meet their obligations as healthcare providers under novel circumstances. This study aims at exploring how trainees perceive their commitments as physicians under the threat of a pandemic. DESIGN: A qualitative method was employed. Researchers interviewed medical students under clerkship training (fifth and sixth-year medical students) and new physicians undergoing postgraduate year (PGY) and specialty training. SETTING: A university hospital in Taipei, Taiwan. PARTICIPANTS: The team conducted three focus groups for participants in three separate training stages: clerks, PGY students (PGYs), and residents. Researchers collected data from 31 March to 2 April 2020 and analysed the thematic analysis results. RESULTS: Seventeen medical students and new physicians took part in the focus groups, five of whom (31.25%) were female. Participants consisted of four residents, six PGYs, and seven medical students. Through their responses, the authors determined four major dimensions with corresponding subdimensions that significantly affected their sense of medical professionalism, including medical knowledge and clinical skills, sense of duty towards public health, teamwork and protection of patient rights. CONCLUSIONS: We therefore concluded that participants grew to accept their roles after acquiring the knowledge and skills needed to care for patients with COVID-19. Alternative teaching arrangements and their impact on trainees' clinical performance require further discussion.

Developing an Instrument to Evaluate Undergraduate Healthcare Students' Professionalism.

Professionalism is a multidimensional quality acquired over time. Undergraduate years lay a foundation for the development of professionalism. Tools monitoring the students' professional development are needed. Our tool development followed three phases: 1) identifying meaningful criteria for professionalism adapted to the education level, 2) developing an evaluation instrument in a process maximising construct validity, 3) testing the evaluation instrument in an interprofessional study. The evaluation instrument proved to be applicable in the field and it meets validity standards. Some differences between professions were found and discussed. Professionality starts to develop during the education, and early monitoring is important to support students' optimal development. The evaluation instrument supports both self- and expert evaluation of healthcare students' professional development.