Preclerkship medical students' perceptions of medical professionalism in the College of Medicine-University of Sharjah: A vision to sustain success in medical education
Mohamed Elhassan Abdalla1, Nihar Ranjan Dash2, Sarra Shorbagi2, Mohamed H Ahmed3
1 College of Medicine; Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
2 College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
3 Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
|Date of Submission||24-Sep-2019|
|Date of Acceptance||01-Apr-2020|
|Date of Web Publication||28-May-2020|
Dr. Mohamed Elhassan Abdalla
Medical Education Center, College of Medicine, University of Sharjah, Post Box: 27272, Sharjah
United Arab Emirates
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Professionalism is an essential theme in both undergraduate and postgraduate medical education. The current study aimed to assess the preclerkship medical students' perception on medical professionalism.
METHODS: A cross-sectional qualitative study using the critical incident technique was conducted at the University of Sharjah in the United Arab Emirates (UAE). An online survey was sent to 300 medical students (years 1–3). Participants were asked to describe an official doctor–patient encounter that they have experienced in a health-care setting and to highlight the professional behaviors in that encounter. They were then requested to list the top five characteristics of a professional doctor. Thirty (10%) medical students responded to the study; only 13 reported real incidents. The responses were independently reviewed by the authors. The descriptions of the professional attitudes were grouped according to the six domains of professionalism defined by the American Board of Internal Medicine (ABIM) Physicians Charter and then plotted against the nine domains of medical professionalism published in the UAE Consensus Statement.
RESULTS: The most common professional behaviors reported were patience, honesty, respect, and patient care. The participants addressed all six domains of professionalism described by the ABIM physicians charter (altruism, accountability, duty , excellence, honor and integrity, and respect for others) and all the domains of medical professionalism published in the UAE Consensus Statement, except for “commitment to advocacy” and “commitment to education” domains.
CONCLUSION: Preclerkship medical students had an insight about the professional behaviors needed from doctors before formal teaching about professionalism in the curriculum.
Keywords: Professionalism, undergraduate, University of Sharjah
|How to cite this article:|
Abdalla ME, Dash NR, Shorbagi S, Ahmed MH. Preclerkship medical students' perceptions of medical professionalism in the College of Medicine-University of Sharjah: A vision to sustain success in medical education. J Edu Health Promot 2020;9:119
|How to cite this URL:|
Abdalla ME, Dash NR, Shorbagi S, Ahmed MH. Preclerkship medical students' perceptions of medical professionalism in the College of Medicine-University of Sharjah: A vision to sustain success in medical education. J Edu Health Promot [serial online] 2020 [cited 2021 Jun 13];9:119. Available from: https://www.jehp.net/text.asp?2020/9/1/119/285158
| Introduction|| |
Professionalism in the medical profession, as defined by the American Board of Internal Medicine (ABIM) in 1990, composed of three commitments: high commitment to excellence, interest in patient welfare, and responsiveness to the health needs of society. The definition also mentioned six elements of professionalism (altruism, accountability, duty, excellence, honor and integrity, and respect for others).
In the current era of competency-based medical education, teaching and acquisition of professionalism are considered a fundamental requirement for the physicians' ultimate societal responsibilities. The American Association of Medical Colleges have proposed professionalism to be considered as an essential part of the curriculum in medical schools. Furthermore, the CanMeds in Canada, the Accreditation Commission for Graduate Medical Education in the USA, and SaudiMeds in Saudi Arabia  have included professionalism as one of the competencies in their graduate profiles. Accreditation standards, such as the Liaison Committee on Medical Education  and the World Federation for Medical Education, have also incorporated professionalism as one of the critical competencies to be gained by students and health professionals.
To understand and plan for the development of professionalism, studies on perception and the latent traits of its concepts have been conducted in different countries. An excellent example of this type of study was performed in Taiwan. The 32-item questionnaire used to assess professionalism was derived from the definition of the ABIM. The three traits perceived as most important were accountability to patients, respect for patients and families, and integrity and prudence. A study conducted in Australia to measure students' perceptions of professionalism and the teaching of professionalism, students defined professionalism variously using ethics, communication skills, and excellent behavior as the central themes in their definitions. Some of the students viewed professionalism as a trait related to personal character and upbringing.
In another study by Mann et al., that sought to determine the perceptions of professionalism by students, faculty, and residents, differing understandings of the concept were revealed among various groups. The qualitative data generated in the study through focus group discussions raised the following themes that were deemed essential for professionalism: knowledge and skills, trust and confidence, and compassion and maturity. Such variation in perception may lead to differences in teaching and the delivery of messages about professionalism.
Studies of future physicians' perceptions of professionalism could aid in the development and re-shaping of medical school curricula about professionalism. Most studies on professionalism have concentrated on ethics and ethical decision-making, whereas few studies have concentrated on the application of the study's results to improve teaching and assessment of professionalism.
The study of professionalism is not common in the Middle-Eastern region, and very few studies and publications have explored professionalism within this regional context. A recent study in the Arab world to contextualize the concept of professionalism resulted in the validation of the ABIM domains of professionalism in the Arabian context and the addition of a seventh domain: professional autonomy. Another study led to the development of the Learner's Attitude of Medical Professionalism Scale.
In this study, the authors aimed to determine undergraduate medical students' perceptions of medical professionalism in the College of Medicine at University of Sharjah (UoS), United Arab Emirates (UAE) based on their real-life definitions before a formal study is conducted.
| Methods|| |
The College of Medicine at the UoS, UAE, has a 6-year curriculum; foundation year, preclerkship phase (years 1–3), and clerkship phase (years 4 and 5). The formal teaching of professionalism starts in the clerkship phase.
The study recruited students from the academic years in the preclerkship phase (years 1–3) who were not exposed to formal teaching on professionalism; assumping that professionalism is a trait that can be extrapolated from daily life and that education can be directed toward supporting the existing good behaviors.
A cross-sectional qualitative study using critical incident technique (CIT) was conducted at the UoS in UAE. Approval for the study was obtained from the Research Ethics Committee at the UoS. Participants were asked to think of an incident that they had observed or heard about regarding a doctor dealing with a patient during official working hours in a hospital or clinic. Then, if the participants viewed the doctor's behavior as professional, they were asked to describe the incident and the professional behavior in one or two sentences. The participants were also asked to list the top five characteristics of a professional doctor according to their own opinions.
The data were collected electronically through an anonymous online survey using © 1999-2017 SurveyMonkey software. An invitation with a link to the study was sent to students in the designated academic years (n = 300) through their registered official e-mails by the academic coordinator of the college of medicine, the invitation indicated that participation in the study is optional. The web survey remained open for 2 months. Thirty (10%) medical students responded to the study, but only 13 reported real incidents.
The responses were reviewed by the authors independently, and the students' descriptions of the professional behavior were compared to the registered incidents. Incidents were reported as they were given, with only the removal of names and some language editing or explanations.
Descriptions of the professional attitudes were grouped according to the six domains of professionalism defined by the ABIM Physicians Charter and then plotted against the domains of professionalism in the UAE context published by Abdel-Razig et al.
| Results|| |
Professional attitude description and categories
Incidents were reported from seven males and six females, including two from year 1, seven from year 2, and four from year 3. The most common professional behaviors reported were patience, honesty, care, and respect; the other professional behaviors described are listed in [Table 1].
The described behaviors were grouped according to the six domains of medical professionalism described by the ABIM Physicians Charter. The students addressed all six domains of professionalism in the charter; the domains and associated critical incidents are listed in [Table 2].
|Table 2: Perceived professional behaviors, incidents and American Board of Internal Medicine physicians charter professionalism domain|
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The incidents were then plotted against the domains of medical professionalism published in the UAE Consensus Statement, as shown in [Table 3]. All of the domains were covered except “commitment to advocacy” and “commitment to education” domains.
|Table 3: Incidents and the domains of the United Arab Emirates framework of medical professionalism|
Click here to view
| Discussion|| |
In professionalism, no one size fits all, and the effect of culture is evident and should be considered. This study uses the CIT, which is a short narrative account describing a personal experience. This technique is used to study and explain values and attitudes because it reflects an honest expression by the respondent. The researchers chose this method to study the perceptions of students toward medical professionalism because the use of checklists of behaviors may not be able to capture behaviors associated with professionalism. Among the difficulties related to professionalism, there is conspicuous deficiency in its assessment procedure which is largely based on traditional methods. While students' achievements were measured by these old-style methods, few attempts have been made to assess students' attitude toward professionalism  or their perceptions of this competency. Many studies have found that assessments of professionalism are not genuine, are too narrowly focused, and reflect what teachers want to hear. In a study conducted in Australia, some students viewed the assessment methods used for professionalism as small and arbitrary.
In this study, students provided many descriptions of the professional behaviors needed by doctors, most commonly including honesty, patience, respect, and giving care. The responses described covered all aspects of the ABIM Physicians Charter. The behaviors mentioned by the students were plotted against the professionalism framework published in the UAE, which was the country where we performed our study. The incidents covered all areas of the framework except “commitment to advocacy” and “commitment to education.” The reason for these omissions might be related to the fact that the participants were in the preclerkship phase of their medical school journey. The omission of these domains may raise the issue of a change in perception of professionalism among medical students at different levels and among practitioners. Of critical concern for professionalism is that students receive mixed messages about professionalism from the message that they are taught and the message that may be obtained in the absence of professional role models.
Another factor that has drawn attention to the issue of professionalism is the influence of sociocultural and economic factors on health. Professionalism is considered a sensitive social construct and is regarded as part of the contract between the doctor and society., In the publication investigating professionalism in the Arab world, Al-Eraky and Chandratilake mentioned professional autonomy as a seventh aspect of professionalism in addition to the six domains published by the ABIM physicians charter). In our study, professional autonomy was not mentioned, which might reflect the need for further research on the effect of culture on professionalism.
Professionalism is a conceptual issue that requires clarification. One difficulty is that professionalism is defined in the literature in many ways. Professionalism is sometimes described with vague terms, such as excellence, altruism, and humanism, or as a concept that can be understood through honesty and humanity.,, Tsai et al. reported that professionalism had more than one hundred definitions in the literature because the definition differed between professionals and across different sociocultural environments.
Although the study has limitations; mainly, the relatively small number of participants and the qualitative nature of the data. Yet, we believe the study is novel, shedding light on a gray area in medical education related to professionalism.
| Conclusion and Recommendations|| |
The results of this research concluded that medical students have insight into the professional behaviors needed from doctors even before the formal teaching about professionalism in the curriculum. Medical educators could direct the teaching in medical program to support the existing professional behaviors of students as they progress in their learning journey. Further research is needed to determine the effect of factors – other than the curriculum – that may shape the professional behaviors of doctors and health professionals. The results in this study need to be supported by similar studies in other institutions.
We are grateful for medical students at UoS for participation in this study.
Financial support and sponsorship
This work is self-funded.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]