a pilot study on professionalism of future medical professionals in universiti kebangsaan malaysia...

Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540

1877-0428 © 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and Learning Congress 2011doi: 10.1016/j.sbspro.2012.09.419

UKM Teaching and Learning Congress 2011

A pilot study on professionalism of future medical professionals in Universiti Kebangsaan Malaysia (UKM) Medical Centre Abdus Salama*, Chew Ooi Songb, Nur Farhana Mazlanb, Hayati Hassinb

Lim Soon Leeb, Muhammad Hazwan Abdullahb

aDepartment of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia bFifth Year Medical Students, Universiti Kebangsaan Malaysia

Abstract

Professionalism is a multidimensional concept but there are core professionalism issues which are unique for all professions. A pilot study was conducted in 2011among 50-UKM-medical students chosen randomly from year 1-5 to investigate their professionalism. Data was collected using a developed instrument concerning 40 items, assessed using 5-point Likert scale under nine core issues. Total mean professionalism score for all nine issues in year-1 students was 178/220 and in the subsequent years were 169/220, 173/220, 171/220 and 175/220. Internal consistency of the instrument was adequate. Educators especially the faculty should emphasize on core professionalism issues to promote professionalism in future professionals. © 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and Learning Congress 2011.

Keywords: Academic medical centre; future medical professionals; pilot study; professionalism

1. Introduction

Professionalism is an umbrella concept used to describe many different aspects of a profession (Wilensky 1964). A profession is an occupation that requires prolong training and formal qualification (Cruess et al., 2004; Freidson, 2001). ‘Professions’ are groups, which announce in a public way that their members will act in certain ways, and that the group and society may discipline those who fail to do so; people who choose the profession had history of doing ‘good’ or one can say ‘good’ people had chosen the profession (Faiz, 2003). Moloney (1986) describes professionalism as commitment to ones’ work and the orientation towards service rather than personal profit. Members of a profession are governed by codes of ethics to the promotion of public good within their domain (Cruess et al., 2004). Customer service, work ethics and business integrity are often grouped together with professionalism.

* Corresponding author. Tel.: +6-03-9145-7973; fax: +6-03-9145-6678 E-mail address: [email protected]

Available online at www.sciencedirect.com

© 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and Learning Congress 2011

535 Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540

Many people think they are professionals and used the word ‘professionalism’ differently for different reasons (Swick, 2000). Professional proficiency is of utmost importance to accomplish the practice of a profession efficiently (Salam et al., 2008c; Villegas-Alvarez et al., 2007). Professional proficiency comprises a set of core values or fundamental elements in addition to mastery of broad scientific knowledge and skills of a profession and these are the aspects of humanism. Professionalism although is an umbrella or multidimensional concept, its core values or humanistic aspects such as respect, accountability, responsibility, caring, leadership, altruism, compassion etc. (Maryland, 2002) are unique and equally applicable to all professions.

Medicine is a profession that requires high standards of behavior in terms of core values of professionalism, such as who can communicate effectively with patients, patients’ families and colleagues; act in a professional manner, be aware of socio-cultural diversities, values, prejudices, and provide care with understanding of those values and various dimensions of patient’s lives (Salam & Rabeya, 2009; Litzelman & Cottingham, 2007). The corporate transformations of health care system erode the professionalism of physician (Sullivan, 1999; Swick et al., 1999). Poor communication aspects of physicians (Salam et al., 2008a) and lack in practice of core issues of professionalism .make general public and patients even colleagues, more dissatisfied than deficiency in any other clinical competencies in the medical profession. Medical educators are already concerned about the erosion of medical professionalism because of the attitudes and behaviors of practicing physicians, particularly by the faculty (Swick et al., 1999). Students who are the customers of medical educational industry are seldom aware of the core issues or humanistic aspect of professionalism (Project professionalism, 1995). Medical students often receive contradictory messages between what they hear in the class room and what they see in the real setting about core values to demonstrate (Inui, 2003; Hafferty & Franks, 1994; Reynolds, 1994). If faculties are responsible for teaching professionalism but fail to demonstrate its core issues before their students by not doing so, then clearly professionalism is missing in the students’ education; so the contemporary medical student tends to become less idealistic by his or her fourth medical year (Christian, 2008; Hilton & Slotnick, 2005) even though they read by themselves and hear formally about core issues of professionalism. Students tend to do so as their teachers do (Christian, 2008; Feudtner, 1994; Hafferty & Franks, 1994). As such, there is growing consensus among medical educators to promote professionalism in medical students (Litzelman & Cottingham, 2007) especially to expand the core humanistic aspects. The purpose of this pilot study was to test the feasibility of research in order to identify the conceptual understanding of professionalism with emphasis on its core issues among medical students in the UKM Medical Centre aimed at professional development of future medical professionals.

2. Methodology

This was a cross sectional study on core values of professionalism, piloted in early 2011 among medical students of UKM Medical Centre. A sample of 50 students comprising of 10 students from each year of 1-5 of academic session 2010-2011 was chosen randomly, using stratified sampling technique. An instrument on professionalism was developed through extensive review of literature, which contained nine core professionalism attributes such as honesty, accountability, confidentiality, respectfulness, responsibility, compassion, communication, maturity and self-directed learning. There were a range of statements under each professionalism issues which was assessed using a 5-point Likert scale. Mean of all nine attributes’ scores represented the professionalism of respondents as a whole. The instruments also contained four open ended questions researching about respondents’ opinion on what professionalism meant to them, how professionalism should be taught, how they learnt professionalism and how professionalism should be assessed. The data was then compiled and analysed using SPSS version 17.

3. Results

Out of 50 respondents, 40% were male and 60% were female (Fig-1). Scores of different elements of professionalism between male and female respondents are shown in Table-1, which are almost similar. Scores of different elements of professionalism among the respondents of different study-years are shown in Table-2, which are also almost similar. Of a maximum total professionalism score of 220, mean score of first year students was 178 and subsequent years were 169, 173, 171 and 175 respectively (Fig-2).

Research on what professionalism is meant to the respondents, how it should be taught, how they learnt and how professionalism should be assessed are shown in Table 3. This table revealed that professionalism means positive


attitude and behaviour towards job as expressed by 46% respondents while 8% respondents were unaware of professionalism and the rest defined it in other ways. Thirty four percent of the respondents stated that professionalism should be taught through experience and more than that (38%) felt that they learnt professionalism through experience. Half of the respondents reported that professionalism should be assessed formally.

40%60%

Male

Female

Figure 1. Gender distribution of the respondents

Table 1. Gender-wise scores of elements of professionalism as well as mean scores of all elements, n=50

Element of professionalism

Maximum scores

Gender-wise scores of core elements of professionalism

Male (n=20) Female (n=30)

Honesty 30 23.75 21.17

Accountability 25 18.70 18.87

Confidentiality 20 15.85 16.37

Respectful 30 24.65 24.10

Responsibility 30 23.45 24.00

Compassion 20 16.50 16.93

Communication 25 19.70 19.43

Maturity 30 22.55 23.63

Self-directed learning 10 8.35 8.33

Mean scores of all elements

220 173.50 172.83


Table 2. Year-wise scores of core elements of professionalism as well as mean scores of all elements, n=50

Elements of

Professionalism

Maximum

scores

Year-wise scores of core elements of professionalism

First year (n=10)

Second year (n=10)

Third year (n=10)

Fourth year (n=10)

Fifth year (n=10)

Honesty 30 23.84 23.38 20.42 22.83 21.84

Accountability 25 20.21 18.16 18.21 18.59 18.75

Confidentiality 20 16.91 15.75 17.54 15.21 15.12

Respectful 30 24.59 23.21 24.33 24.67 25.09

Responsibility 30 24.50 23.04 24.21 22.54 24.34

Compassion 20 17.71 15.96 16.84 16.25 16.84

Communication 25 20.42 18.17 19.83 19.16 20.25

Maturity 30 21.66 23.00 23.42 23.21 24.17

Self-directed learning 10 8.58 8.04 7.91 8.50 8.67

Mean score of all elements

220 178.42 168.71 172.71 170.96 175.07

164

166

168

170

172

174

176

178

180

1st year 2nd Year 3rd Year 4th Year 5th year

Figure 2. Mean professionalism scores among the respondents of different study-years (maximum score 220)


Table 3. Respondents’ opinion through open ended questions on researching what professionalism is meant to them, how it should be taught, how they learnt professionalism and how it should be assessed.

What do you mean by

professionalism? How professionalism should

be taught? How do you learn professionalism?

How professionalism should be assessed?

Opinion n % Opinion n % Opinion n % Opinion n % Positive attitude and behaviour towards job

23

46

Experience

17

34

Experience

19

38

Formally

25

50

Others

20

40

Formal education

16 32 Role model

12 24 Others 10 20

Unsure

4

8

Role model

8

16

Others 9 18 Feedback and self-reflection

7 14

Skilful 3 6 Others 5 10 Formal education

7 14 Unsure

7

14

Unsure 4 8 Unsure

3

6 Can not

1

2

Total

50

100

Total

50

100

Total

50

100

Total

50

100

4. Discussion

Medicine is a profession that forms the basis of contract between doctors and society (Hilton, 2005; Irvine, 2003). The professional role of physicians involves a commitment to uphold social order by providing good moral judgment, and ethical practices of medicine (Bryan et al., 2005; Patenaud et al., 2003; ABIM, 2002; Fadar et al., 1989). The aim of physician is to cure sometimes, relieve often and comfort always (Salam et al., 2008a; Lloyd and Bor, 1996). To comfort always, medical professionals requires a high standard of behavior that ensures use of core issues of professionalism in addition to the mastery of a large body of knowledge and clinical skills (Litzelman & Cottingham, 2007).

This study was about a group of UKM medical students where the number of female students is more than male students (Fig-1). In terms of scores of core elements of professionalism such as honesty, accountability, confidentiality, respectful, responsibility, compassion, communication, maturity and self-directed learning between male and female respondents with varying educational background were found to be almost similar with slightly high score (173.50) obtained by male respondents than female (Table-1). Nath et al., (2006) expressed that the core values of professionalism may vary widely with gender, study-year and socio-cultural background. Professionalism score in its core issues among the respondents of different study-years also were found closely similar (Table-2). Environment plays a vital role in influencing the development of professionalism (Cruess et al., 2008). The closely similar scores in core issues of professionalism between different gender and study-years of the respondents in this study may reflect that a non-threatening collaborative educational environment is maintained in the institution. To promote any educational development, intradepartmental and interdepartmental support and collaboration is very much important rather than any competitive efforts. Brown et al., (2009) and Duke et al., (2005) reported that students’ attitudes toward professionalism tend to deteriorate during their years of training. This study revealed that out of a total score of 220, first year students scored 178 and the subsequent years scored 169, 173, 171, 175 and 173 respectively (Fig-2), which is consistent with the reports made by Brown et al., and Duke et al.

Answering to an open ended question, what professionalism is meant to them, 46% respondents stated that professionalism means positive attitudes and behaviour towards job, 8% were unaware of its meaning and the rest defined professionalism in different ways (Table-3). This finding has similarities with the statement made by Swick (2000) where it is mentioned that professionalism is easy to recognize but difficult to define as different people use the word differently for different reasons. Here is the educators’ role to put emphasis on clear understanding and practice on core issues or humanistic aspect of professionalism. Professional development is difficult if the academy lacks consensus on clear understanding of the core issues of professionalism (Brown et al., 2009).


Professionalism may be inherent to socio-cultural background and past experience (Nath et al., 2006), but lecturers play important role in the development of student’ skills during their undergraduate course (Salam et al., 2011c; Nabishah et al., 2009). Many studies reported that, the personality of a lecturer has a strong effect on the development of professionalism to their students (Haghdoost & Shakibi, 2006; Gillespie, 2002; Pelaez & Gonzalez, 2002; Kiker, 1973). Thirty four percent respondents in the present study opined that professionalism should be taught through experience while 38% and 24% respondents felt that they learnt professionalism through experience and role model respectively (Table-3). Various studies reported that professionalism is best learned from faculty role models (Salam et al., 2010b; Brown et al., 2009; Cruess et al., 2008; Goldie et al., 2007; Cote & Leclere, 2000; Reynolds, 1994). Findings of the present study regarding learning professionalism through role models have similarities with various other study reports. Role models are those who teach by example (Kenny et al., 2003; Robert, 2001) and it is the educational process through which students learn the skills of observation, communication and professionalism (Salam et al., 2011b).

Teaching professionalism through formal education is now very much accepted (Hilton, 2005; Irvine, 2003). But this study found that students ranked the formal education at second position when they were asked “how professionalism should be taught,” and ranked formal education at fourth position when asked “how do you learn professionalism”; half of the respondents felt that professionalism should be assessed formally. Students emphasized on experience and role model in regards to learning of their professionalism (Table-3), which indicates that role model has great role in teaching professionalism through formal education. Excellent role models always inspire and ensure simplicity and specificity of an educational programme in order to have a common understanding of the core concepts and to achieve crystal-clear learning outcomes (Brown et al., 2009).

5. Conclusion

This pilot study found that majority of the UKM medical students has common conceptual understanding on core issues or humanistic aspects of professionalism with insignificant differences between gender and study-years. Priority has been given to experience and role modeling in order to promote professional development of future medical professionals. The internal consistency of this research instrument was adequate. It is concluded that research on core issues or humanistic aspects of professionalism among UKM medical students is feasible. Educators need to emphasize on the practice of core issues of professionalism, especially by faculty to develop professionalism to their medical students, ultimate aim of which is to ensure delivery of quality health care system for the welfare of society.

Acknowledgement

We would like to thank Universiti Kebangsaan Malaysia for providing the research grant FF-020-2011.

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a pilot study on professionalism of future medical professionals in universiti kebangsaan malaysia...

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