Pre-clerkship medical students' perceptions of medical professionalism

Abstract

Background: Professionalism instruction and assessment is a core component of medical education, and essential for professional identity formation (PIF). Thus, understanding the socialization of medical students to the values of the profession (i.e., medical professionalism), and how these may evolve, warrants continued understanding. Methods: The purpose of this study was to examine and compare pre-clerkship (first and second year) medical students' perceptions of professionalism. First and second year medical students participate in this study. This was a two-phase mixed-methods cohort study conducted across two academic years (2014-2015 and 2015-2016). In Phase I, first and second year medical students participated in a nominal group technique (NGT) session. NGT data was analyzed qualitatively to generate a card-sorting exercise of professionalism attributes for Phase II. In Phase II, data from the sorting task was analyzed using Principle Component Analysis (PCA). Results: The PCA for first year students derived a 7-factor solution. Factors (i.e., professionalism domains) identified were: Self-management and patient-centeredness, ethics and professional reputation, dependability, self-awareness and self-improvement, image, proficiency and lifelong learning and integrity. The PCA for second year students derived a 5-factor solution; factors identified were: "Good Doctor" attributes, responsibility, ethics, innovation and self-improvement and unbiased. Conclusions: Identification and organization of attributes into an overarching professionalism mental model provide a window into the active reconstruction of students' professional identity during the nascent stages of medical education. M1 professionalism domains were more consistent with the conventional professional image of the physician (e.g. Ethics and Professional reputation, Dependability, Integrity), whereas, M2 domains reflected a more global view (e.g., "Good Doctor" attributes, Responsibility, Ethics). This study provides a lens into the dynamic nature of students' PIF and encourages educators to evaluate PIF pedagogy at their own institutions.