Development and validation of a professionalism assessment scale for medical students

Validity and reliability of the Professionalism Assessment Scale in Turkish medical students

Medical professionalism is a basic competency in medical education. This study aimed to adapt the Professionalism Assessment Scale, which is used to evaluate the professionalism attitudes of medical students, into Turkish and to assess its validity and reliability. First, the scale's translation-back-translation was performed and piloted on 30 students. Then, the final scale was applied to medical students to ensure the scale's validity. The Penn State University College of Medicine Professionalism Questionnaire was used for external validation to assess criterion validity. Confirmatory factor analysis was performed for structure validity. Test-retest, item correlations, split-half analysis, and Cronbach's alpha coefficient were evaluated to determine the scale's reliability. SPSS 25.0 and AMOS 24.0 package programs were used for statistical analysis. The statistical significance level was accepted as P<0.05. The mean age of the participants was 21±2 years, and 50.5% (n = 166) were female. Three hundred thirty-five students were invited, and 329 participated in the study. The response rate was 98%. The mean total Professionalism Assessment Scale score was 96.36±12.04. The three-factor structure of the scale, "empathy and humanism," "professional relationship and development," and "responsibility," was confirmed. The Cronbach's alpha coefficient of the scale was 0.94, and both the Spearman-Brown and Guttman split-half coefficients were 0.89. The three-factor structure of the scale, consisting of 22 items, explained 59.1% of the total variance. The intraclass correlation coefficient between test-retest measurements was 0.81. Confirmatory factor analysis showed a model suitable for the original version of the scale (χ2/sd = 2.814, RMSEA = 0.074). The Turkish version of the Professionalism Assessment Scale is a valid and reliable tool to determine the professionalism attitudes of medical students in Turkey.

Developing an Instrument to Evaluate Undergraduate Healthcare Students' Professionalism

Professionalism is a multidimensional quality acquired over time. Undergraduate years lay a foundation for the development of professionalism. Tools monitoring the students' professional development are needed. Our tool development followed three phases: 1) identifying meaningful criteria for professionalism adapted to the education level, 2) developing an evaluation instrument in a process maximising construct validity, 3) testing the evaluation instrument in an interprofessional study. The evaluation instrument proved to be applicable in the field and it meets validity standards. Some differences between professions were found and discussed. Professionality starts to develop during the education, and early monitoring is important to support students' optimal development. The evaluation instrument supports both self- and expert evaluation of healthcare students' professional development.

Scoping Review of frequently highlighted attributes of Medical Professionalism in an Undergraduate Medical Education Context

Background and Objectives:

Medical Professionalism (MP) establishes the trust between society and doctors. We aimed at finding frequently highlighted qualities of MP in the literature.

Methods:

We searched PubMed and Scopus for attributes of MP, using terms, “Professionalism,” “Medical Students,” and “Undergraduate Medical Education”. We included English language, original research articles with MP attributes from the perspective of undergraduate medical education, any nationality, race, gender, and age range, as the central topic of the article. Papers published from January 1^st 1986 to 29^th February 2020 were included.

Results:

From 1349 identified articles, finally, 18 were included, authored in 10 countries, collectively contributing to answering the scoping review question. Two themes were identified: (1)Nurturing of MP, 11 (61.11%) out of 18 included articles, highlighted “respect” as the most dominant attribute as it appeared in 6 (54.55%) out of 11 reviews, “communication” 5 (45.45 %) studies and “honesty” and “integrity” 4 (36.36%). (2)Assessment of MP, 7 (38.89%) studies, and majority, 4 (57.14 %) assessed MP using American Board of Internal Medicine’s elements of MP, viz, “altruism, accountability, excellence, duty, honor and integrity, respect for others.”

Conclusions:

Themes exemplified MP’s most discoursed issues. The attributes are frequently used worldwide. MP deliberates as a commitment toward the individual patient, society, and necessitates transforming from its present generic form to more explicit details.

Linguistic analysis of empathy in medical school admission essays

OBJECTIVES

This study aimed to determine whether words used in medical school admissions essays can predict physician empathy.

METHODS

A computational form of linguistic analysis was used for the content analysis of medical school admissions essays. Words in medical school admissions essays were computationally grouped into 20 'topics' which were then correlated with scores on the Jefferson Scale of Empathy. The study sample included 1,805 matriculants (between 2008-2015) at a single medical college in the North East of the United States who wrote an admissions essay and completed the Jefferson Scale of Empathy at matriculation.

RESULTS

After correcting for multiple comparisons and controlling for gender, the Jefferson Scale of Empathy scores significantly correlated with a linguistic topic (r = .074, p < .05). This topic was comprised of specific words used in essays such as "understanding," "compassion," "empathy," "feeling," and "trust." These words are related to themes emphasized in both theoretical writing and empirical studies on physician empathy.

CONCLUSIONS

This study demonstrates that physician empathy can be predicted from medical school admission essays. The implications of this methodological capability, i.e. to quantitatively associate linguistic features or words with psychometric outcomes, bears on the future of medical education research and admissions. In particular, these findings suggest that those responsible for medical school admissions could identify more empathetic applicants based on the language of their application essays.

Physicians' Attitudes Toward Adolescent Confidentiality Services: Scale Development and Validation

Introduction

Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical acceptability of confidential services in adolescents’ healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents’ access and utilization of healthcare services. Despite legal policies that promote adolescents’ rights, physicians’ attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents’ confidentiality.

Method

A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations.

Results

Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents.

Conclusions

The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians’ awareness of the importance of adolescent confidentiality.

An Exploration of Medical Education in Central and Southern China: Measuring the Professional Competence of Clinical Undergraduates

Background: The cultivation and assessment of the professional competence of clinical undergraduates is essential to medical education. This study aimed to construct a scale to evaluate the professional competence of clinical undergraduates as well as its determinants. Methods: The competence scale was developed on the basis of four medical education standards, the literature, and expert interviews. A total of 288 undergraduates from two types of medical colleges in central and southeastern China were selected by a multistage sampling strategy. Factor analysis, correlation analysis, and internal consistency reliability were used to verify the validity and reliability of the scale. Results: A scale consisting of eight factors with 51 items was determined for factor analysis. Cronbach’α coefficients among the eight dimensions were over 0.800, with mean scores of 1.76, 1.38, 1.92, 1.54, 1.77, 1.25, 1.60, and 2.34. Clinical undergraduates with above average academic grades achieved a higher score in essential clinical knowledge (p < 0.05) and better professionalism was reported among females (p < 0.05). Conclusion: The competence scale showed excellent reliability and validity. Respondents in this study showed a moderate level of professional competence. This study could be a reference for medical educators and policy makers in order to improve medical education standards for clinical undergraduates in China and other countries with similar settings.

Attitudes toward professionalism in medical students and its associations with personal characteristics and values: a national multicentre study from Slovenia raising the question of the need to rethink professionalism

Background: Professionalism is becoming one of the main competencies that all medical students should develop during their education. The attitudes of medical students to professionalism in the study process can change, depending on the curriculum and methods of teaching. Factors associated with attitudes to professionalism can be divided into the characteristics of the physician and the context, eg, education about professionalism and the health system; however other student characteristics are also important. This study focused on the factors associated with attitudes toward professionalism and took into account student demographic characteristics, personality and their personal values. Methods: A convenience sampling method was employed in the academic year 2015-2016 in the fourth and final year medical students at the two Medical Faculties in Slovenia. The instrument consisted of questionnaires examining the Big Five personality traits questionairre (BFQ), the scale of personal values and demographic and family background data. The outcome measure was the validated professionalism attitude scale (PAS). Results: A total of 323 students participated, of which 101 (31.3%) were men and 222 (68.7%) were women. The samples of the two faculties did not differ in any demographic characteristics and were analyzed together. Of the personal values, partner/love, profession/work and sport activity were significantly associated with the total score of the PAS (β=0.22, p=0.033; β=0.24, p=0.003; β=0.17, p=0.040, respectively). After the adjustments for the BFQ dimensions, only profession/work kept significance (β=0.19, p=0.016). Women scored significantly higher on attitudes toward professionalism (total PAS score: M_w=93.4±5.1, M_m=89.1±9.8, p=0.001), and this significance remained in multivariate modeling (β=-0.20, p=0.001). Of the hereditary traits, only acceptability was associated with attitudes toward professionalism (β=0.25, p<0.001). Conclusions: It seems that personal characteristics and values are important in students` concept of their future professional behavior. Further research will show whether these patterns are prerequisites for enrollment in the study process.

[Analysis of the discrimination of the final marks after the first computerized national ranking exam in Medicine in June 2016 in France]

INTRODUCTION

The first computerised national ranking exam (cNRE) in Medicine was introduced in June 2016 for 8214 students. It was made of 18 progressive clinical cases (PCCs) with multiple choice questions (MCQs), 120 independent MCQs and 2 scientific articles to criticize. A lack of mark discrimination grounded the cNRE reform. We aimed to assess the discrimination of the final marks after this first cNRE.

METHODS

A national Excel^® file gathering overall statistics and marks were transmitted to the medical faculties after the cNRE. The mean points deviation between two papers and the percentage of points ranking 75% of students allowed us to analyse marks' discrimination.

RESULTS

The national distribution sigmoid curve of the marks is superimposable with previous NRE in 2015. In PCCs, 72% of students were ranked in 1090 points out of 7560 (14%). In independents MCQs, 73% of students were ranked in 434 points out of 2160 (20%). In critical analysis of articles, 75% of students were ranked in 225 points out of 1080 (21%). The above percentages of students are on the plateau of each discrimination curve for PCCs, independent MCQs and critical analysis of scientific articles.

CONCLUSION

The cNRE reduced equally-ranked students compared to 2015, with a mean deviation between two papers of 0.28 in 2016 vs 0.04 in 2015. Despite the new format introduced by the cNRE, 75% of students are still ranked in a low proportion of points that is equivalent to previous NRE in 2015 (between 15 et 20% of points).

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016)

BACKGROUND

Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.

AIM

To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.

METHODS

A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I² statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.

RESULTS

Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.

CONCLUSION

The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

Why Pull the Arrow When You Cannot See the Target? Framing Professionalism Goals in Medical Education

Professionalism is essential for a successful physician-patient relationship and widely acknowledged as an intrinsic and important component of medical education for learners at all levels, from medical school to residency to continuing medical education. The problem is defining the educational end points for learners and then determining how to assess these outcomes. This Invited Commentary focuses on what medical educators can and should do to refine the vision of professionalism in medical education. The authors propose a multistep process in which learners, educators, and the public are engaged in articulating clearly and definitively the end points of professionalism education.

The reliability and validity of a new professionalism assessment scale for young health care workers

With the development of medical technique, many medical challenges have been solved. This cross-sectional study was aimed to assess the reliability and validity of a new developed scale for assessing the professionalism of young health care workers.This cross-sectional population-based study was conducted based on cluster sampling method in 2015. The participants were from 2 medical centers of Nantong city of Jiangsu province in China. The internal consistency reliability was assessed using Cronbach's alpha and split-half reliability coefficients. Construct validity was analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Content, convergent, and discriminant validities were also assessed in this study.Total 749 individuals aged 29.09 ± 3.91 years old participated in this investigation. There were 745 valid questionnaires and 730 were complete. Cronbach's alpha value (0.944) and the split-half reliability coefficient (0.873) reflected satisfactory internal consistency reliability of this new professionalism assessment scale. EFA extracted a 7-factor model. About 63.4% of the total variance was explained by these factors. However, CFA showed a good model fit after excluding the items with factor loading lower than 0.5. Good discriminant validity of this new developed professionalism assessment scale was also shown (P < .05). However, the evidences for content and convergent validity were not enough in this study.The results showed the satisfactory reliability of this new developed professionalism assessment scale. However, this scale should be modified to improve the validity in further studies.

Assessing medical professionalism: A systematic review of instruments and their measurement properties

Background

Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments’ measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.

Methods

A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990–2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument’s usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee’s criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments.

Results

After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar’s instrument for nursing students, Nurse Practitioners’ Roles and Competencies Scale, and Perceived Faculty Competency Inventory.

Conclusion

Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Assessing Empathic Attitudes in Medical Students: The Re-validation of the Jefferson Scale of Empathy-Student Version Report

INTRODUCTION

Self-reported scales, such as the Jefferson Scale of Empathy - Student version (JSE-S), had been recognised to measure the empathic disposition rather than behavioural expression. This study aimed to re-validate the JSE-S and its factor structure prior further research on empathy in medical students.

METHODS

A convenience sampling method was employed in two consecutive academic years, in 2012/13 and 2013/14, at the Faculty of Medicine in Ljubljana, Slovenia; first and final year students participated voluntarily. The JSE-S examined empathy levels. The principal component analysis was performed with Oblimin rotation and Kaisers' criteria. Factors with eigenvalues ≥ 1.25 were retained and items loading ≥ |0.40| were required for the interpretation of the factor structure.

RESULTS

The total study sample size was 845 students, (580 (68.6%)) of them women; 327 (72.2%) were in the first (19.2 ± 1.9 years old) and 253 (61.7%) in the sixth (24.9 ± 1.1 years old) year of medical school. Females achieved higher JSE-S scores in all groups. The three-factor JSE-S was confirmed, but only seven items were concordant in all groups. A higher proportion of explained variation for Perspective Taking and Standing in the Patient's Shoes, and better internal consistency, was found in a reduced-item scale (16-18 items). When performing factor analysis of a seven-item scale, the percentages of explained variance increased with two factors extracted.

CONCLUSIONS

Only the cognitive dimension of JSE-S gave results as expected, therefore proper terminology, i.e. the object of assessment, must be used in further administration of JSE-S and empathy-related research in medical students.