Volume 6 Issue 4 - October 31, 2008
Students’ perception on medical professionalism: the psychometric perspective
Tsuen-Chiuan Tsai1, Chyi-Her Lin2,*, Peter H. Harasym3, Claudio Violato3

1Department of Pediatrics, Taipei Medical University College of Medicine, Taiwan
2College of Medicine National Cheng-Kung University, Taiwan
3Department of Community Health, Faculty of Medicine, University of Calgary, Calgary, Canada
neonate@mail.ncku.edu.tw

Medical Teacher 2007 29:2, 128-134

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Teaching professionalism is essential for professional development in medical education. However, medical professionalism presents a conceptual issue and its meaning should be defined. As Arnold mentioned that “ well circumscribed concept of professionalism can serve as a foundation for future measurement initiative”.  In order to design a curriculum for medical professionalism, we must define the underlying variables or attributes that constitute professionalism. However, there are more than 100 different definitions of medical professionalism. Each one is up to the type and nature of the individual professional organization. Furthermore, its definition may differ by socio-cultural background. There are few studies exploring the psychometric properties of professionalism. The purposes of this study was to identify and define the meaning of the traits underlying the concept of medical professionalism and explore how the Taiwanese 7th years medical students value medical professionalism.

A total of 133 7th year medical students were enrolled. They were either from one medical school or those took their internship at two tertiary care centers in Taiwan. The male to female ratios of them was 3.7:1 and their ages ranged from 24 to 27 years (mean 25.4 years) old. The participants were requested to fill up a questionnaire anonymously. Items of questionnaire reflected the characteristics of medical professionalism defined by the American Board Internal Medicine (ABIM). It includes altruism, accountability, excellence, duty, service, honor, integrity, and respect for others. These encompassed dimensions covering items such as: 1. The highest standards of excellence in the practice of medicine, 2. In generating and disseminating knowledge, 3. To sustain the interests and welfare of patients, 4. To be responsive to the health needs of society. We invited medical experts to review and validate the questionnaire, and translated it to Chinese and then verified by two bilingual persons. A five-point rating scale of importance was used to determine the extent of the respondents’ values.

Description of the principal components of 32 items reflecting medical professionalism was listed in Table 1. Eighty eight percent of the items were considered to be important traits which were defined as mean scores greater than 4. Three items ranked most important by medical students were: accountability to patients, respect for patients and their families, integrity and prudence; three least important items were: enduring unavoidable risks to oneself when patient’s welfare is at stake, accepting inconvenience to meet the needs of ones’ patient and seeking active roles in professional organizations. In addition, 11.3% of the respondents ranked at least one item as not important at all. Only one participant picked maximum three items as the least important for medical professionalism. Analysis revealed that eight factors accounted for 69.6% of the variances (Table 2) including: commitment to patient care, righteous and rule–abiding, pursuing quality patient care, habit of practice, interpersonal relationship, patient-oriented issues, self-development and respect for others. Factor 1 accounted for the major score variance (34.9%). The mean scores of factors ranged from 3.8 to 4.4 and the reliability alphas of the eight factors ranged from 0.86 to 0.66. The meaning of factors No. 1, 2, 3, and 4 agreed with the four elements of medical professionalism proposed by ABIM.
Table 1. Descriptive data of the 32 items of medical professionalism questionnaire: sorting the degree of perceived importance.

Table 2. Factor loadings, reliability, and percent of variance

Majority (88%) of the items were recognized as important traits by the participating 7th year medical students. This result indicates consistence of psychometric perspective in medical professionalism by Taiwanese and ABIM standard.  “Commitment to patient care that may lower physicians’ life quality” is an important attribute and is the spirit of medical professionalism. This item was scored low by medical students and is a warning sign against the medical professionalism. Furthermore, practice habit such as dress cloth or etiquette was not regarded as a key factor for excellence in health care. It may reflect difference in socio-cultural value and health care system between Taiwan and the western society.

The items listed in the questionnaire are all essential attributes for medical profession. Yet 11.3% of the medical students in this survey picked at least one item as non-important. Given the facts that some of the future physicians do not have strong attribute of altruism, medical educators in Taiwan should seriously face these issues and come up strategies to remedy the problems.

Conclusion: The professional traits of Taiwanese medical students identified in this study are highly consistent with items proposed by the ABIM and could be used as references for designing medical curriculum in Taiwan. Their perception on medical professionalism may be related to the unique socio-cultural environment. Whether their attributes of medical professionalism will evolve over the clinical years warrants further investigation.

References
1.American Board of Internal Medicine (2006) Project Professionalism.
2.Arnold, L. (2002) Assessing professional behavior: Yesterday, today, and tomorrow. Academic Medicine  77, pp. 502-515.
3.Elcin, M.,  Odabasi, O.,  Gokler, B.,  Sayek, I.,  Akova, M. and Kiper, N. (2006) Developing and evaluating professionalism. Medical Teacher  28, pp. 36-39.
4.Inui, TS (2003) pp. 11-12. Association of American Medical College , Washington DC
5.Lynch, DC,  Surdyk, PM and Eiser, AR. (2004) Assessing professionalism: A review of the literature. Medical Teacher  26, pp. 366-373.
6.Shrank, WH,  Reed, VA and Jernstedt, GC (2005) Fostering professionalism in medical education: a call for improved assessment and meaningful incentives. Journal of General Internal Medicine  19, pp. 887-892.
7.Veloski, JJ,  Fields, SK,  Boex, JR and Blank, LL (2005) Measuring professionalism: a review of studies with instruments reported in the literature between 1982 and 2002. Academic Medicine  80, pp. 366-370.
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