Professionalism and its forms of assessment in medical students: An integrative review

Carneiro, Mariana Aroucha; Cunha, Silvia de Melo; Feitosa, Elaine Saraiva; Sá, Rejane Brasil; Brilhante, Aline Veras Morais

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Review • Interface 24 • 2020 • https://doi.org/10.1590/Interface.190126 copy

Professionalism and its forms of assessment in medical students: An integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

With the objective of systematizing information on the assessment of professionalism among medical students, an integrative review was carried out in May 2018 in the databases EBSCOhost, LILACS and MEDLINE, via PubMed, from 2013 to 2018. Overall, 12 articles and three thematic axes were found: Professionalism: a multidimensional and undefined construct; The teaching of medical professionalism; and Assessing professionalism: multiple assessment strategies. Assessment through domains such as altruism, responsibility, care and teamwork is frequent, and simulated scenarios, standardized patients, online questionnaires or applications may be used. The importance of modeling in the teaching of professionalism is emphasized, as well as the use of feedback associated with other assessment methods. We concluded that there is not one single concept of professionalism and noticed that better assessments are produced when different methods are associated.

Professionalism; Medical education; Medicine undergraduate course

Title/Authors/Year	Target audience	Utilized instrument	Definition of professionalism	Assessed domains
1. Quantitative and Qualitative Analysis of the Impact of Adoption of a Mobile Application for the Assessment of Professionalism in Medical Trainees Juan C. Cendán; Analia Castiglioni; Tereza R. Johnson; Mike Eakins; Marcia L. Verduin; Abdo Asmar; David Metcalf; Caridad Hernandez – 2017	Residents, students and teachers of the Medicine program Department of Medical Education, University of Central Florida (USA)	PROMOBES - Professional Mobile Monitoring of Behaviors Mobile Application (App) Assessed by a Likert scale	Medicine's contract with society. Dynamic and multi-dimensional construction, encompassing individual factors, learned behaviors, sociocultural aspects and norms	Reliability Responsibility Self-improvement Adaptability Relationships Learning principles Commitment Honesty Altruism Empathy Self-confidence Response in conflict situations Confidentiality
2. Beyond Selection: The Use of Situational Judgement Tests in the Teaching and Assessment of Professionalism Barbara D. Goss; Anna T. Ryan; Joshua Waring; Terry Juud; Neville G. Chiavaroli; MPhil, Richard Charles O’Brien; Stephen C. Trumble; e Geoffrey J. McColl.- 2017	Final-year medical students University of Melbourne/ Australia	Situational judgement test (SJT) Three 40-item tests with relevant scenarios High execution cost Students suggest ideas for the tests (co-participation)	Critical attribute of medicine students that includes technical knowledge, behaviors, moral attitudes and values	Resilience Empathy Behavior Integrity Autonomy Patient focus/safety Communication Confidentiality Reduction in self-interest Recognition of limitations Work-leisure balance Response in conflict situations
3. A qualitative thematic content analysis of medical students’ essays on professionalism So-Youn Park; Changwoo Shon; Oh Jovem Kwon; Tai Young Yoon; Ivo Kwo.- 2017	Medical students Kyung Hee University/ South Korea	Case report on witnessed nonprofessional attitudes with reflections on them	Concept connected with respect, medical responsibility and trust that is a dynamic construction of culture	Interest in the patient Trust Altruism Accountability Peer relationships Communication Respect for patient’s autonomy Honesty Recognition of limitations/mistakes Confidentiality Justice Competency
4. An investigation of professionalismreflected by student comments on formative virtual patient encounters Ting Dong; William Kelly; Meredith Hays; Norman B. Berman; Steven J Durning – 2017	Medical students Bethesda University/USA	MedU Aquifer Platform - virtual Pediatrics, Family Medicine and Internal Medicine patients	Necessary competency for doctors, students and residents that can be summarized as honor, integrity, respect and responsibility	Honor Respect Accountability Integrity
5. Professional Identity Formation in Medical School: One measure reflect changes during pre-clerkship training Adina Kalet; Lynn Buckvar-Keltz; Verna Monson; Victoria Harnik; Seteven Hubbard; Ruth Crowe; Tavinder K. Ark; Hyuksoon S. Song; Linda Tewksbury; Sandra Yingling – 2018	Medical students New York University/USA	Professional Identity Formation (PIF) assessed by the Professional Identity Essay (PIE) Feedback	Reflection of an ongoing developmental process that is shaped by the beliefs and values of the individual as well as by the environment	Professional identity Self-improvement Reflection Socioemotional development Moral principles Resolution of problems Resilience
6. Your professionalism is not my professionalism: congruence and variance in the views of medical students and faculty about professionalism Kamran Sattar, Sue Roff, Sultan Ayoub Meo – 2016	Medical students and teachers King Saud University/ Saudi Arabia	Questionnaire called Dundee Polyprofessionalism Inventory Answers through the Bristol Online Survey	Essential aspect in medical education that must be assessed taking into consideration the sociocultural context; it involves attitudes, values and behaviors that act as the basis of the health professional’s contract with society	Integrity Punctuality Responsibility Reliability Peer relationships Confidentiality Ethics Compliance with rules Behavior Moral principles Honesty Behavior
7. Speaking up: using OSTEs to understand how medical students address professionalism lapses Constance R. Tucker, Beth A. Choby, Andrew Moore, Robert Scott Parker, Benjamin R. Zambeti, Sarah Naids, Jillian Scott, Jennifer Loome; Sierra Gaffney – 2016	Fourth-year medical students University of Tennessee/USA	OSTE (Objective Structured Teaching Encounter) using standardized patients with professionalism lapses, in which students give their opinion about the situation and about how they perceive unprofessional attitudesFeedback	A set of individual behaviors, skills, values, and attitudes in the interaction with patients, families, and other team members	Respect Responsibility Excellence Honor Integrity Altruism Leadership Culture Compassion Confidentiality Interpersonal communication Caring
8. Defining Medical Professionalism Across the Years of Training andExperience at the Uniformed Services University of the Health Sciences Virginia F. Randall, Christopher W. Foster, Cara H. Olsen, Anne B. Warwick, Katrina A. Fernandez, Gary Crouch - 2016	Medical students and teachers Uniformed Services University of the Health Sciences/USA	Questionnaires sent by e-mail to students and teachers about what they understand by professionalism through three words	List of values, desired behaviors and beliefs of how to deliver medical care with ethics	Responsibility Communication Diligence Emotional maturity Ethical Honesty Integrity Patient-first Lifelong-learning Reliability Respect Service Interpersonal relationship Teamwork Compassion Empathy Humanism Selfless
9. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies Lynn V Monrouxe, Charlotte E Rees, Ian Dennis, Stephanie E Wells - 2015	Undergraduate students from many health areas Various universities in the United Kingdom	Online questionnaires about witnessed unprofessional behavior to assess moral distressl Assessed by a Likert scale	Concept guided by morality, empathy, integrity, respect for patient’s dignity and safety	Confidentiality Use of authority Behavior Ethics Morality Dignitiy Safety Empathy Autonomy
10. How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools Deborah Ziring; Deborah Danoff; Suely Grosseman; Debra Langer; Amanda Esposito; Mian Kouresch Jan, Steven Rosenzweig; Dennis Novack – 2015	Deans of medical schools in the USA and Canada Various universities in the USA and Canada	Questionnaire with 16 questions about the assessment of professionalism (identification and correction of lapses) administered by telephone to deans of medical schools	A complex, dynamic, and evolving process based on the competing demands placed on individuals in the context of the organizational environment; product of innate character traits	Responsibility Self-improvement Self-awareness Communication Interpersonal relationship Honesty
11.Professionalism in Plastic Surgery Attitudes, Knowledge, and Behaviors in Medical Students Compared to Surgeons in Training and Practice - One, But Not The Same Charles Scott Hultman; Ida Janelle Wagner – 2015	Fourth-year medical students, surgical residents and surgeons University of North Carolina/USA	Forms with multiple-choice questions about scenarios that depict situations of unprofessional behavior through the program Survey Monkey Assessed by a Likert scale	The ability and willingness to apply knowledge and skill to a greater social good	Communication Behavior Altruism Engagement Autonomy Honesty Confidentiality Respect Self-regulation Self-improvement Integrity Morality Ethics Commitment Teamwork Responsibility Competence
12. Learning medical professionalism with the online concordance-of-judgment learning tool (CJLT): A pilot study Amélie Foucault, Serge Dubé, Nicolas Fernandez, Robert Gagnon; Bernard Charlin – 2015	Third- and fourth-year medical students University of Montreal/ Canada	CJLT (Concordance of Judgement Learning Tool) with 20 clinical cases about professionalism situations that are judged by students Feedback	Fulfilment of roles and competencies and its development involves judging different situations	Not mentioned

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[1] Authors’ contributions

Mariana Aroucha Carneiro conceived and outlined the article. All the authors participated in the critical review of the content and in the approval of the manuscript’s final version.