Enlightenment on the Construction of Medical Professionalism from the Perspective of Moral Injury / 中国医学伦理学

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.

Research on the Role of Voluntary Service in Cultivating the Medical Professionalism of Medical Freshmen: Text Analysis Based on the "Volunteer Star" Deeds of Peking University Premedical Students / 中国医学伦理学

Based on the content of medical professionalism and the theoretical model of knowledge, belief and practice, this paper used the methods of "inductive category construction" and "deductive category construction" to form the categories and analyze the text, taking the narrative materials of 112 "volunteer stars" outstanding individuals selected by the pre-medical student office of student affairs department of Peking University Health Science Center from 2019 to 2021 as the research subjects. The findings demonstrated that volunteer service had a positive effect on the cultivation of medical professionalism of medical freshmen, and played an effective role in guiding medical freshmen from the two dimensions of knowledge and belief, in which the role of medical voluntary service was more obvious. However, the breadth and depth of volunteer service in cultivating medical professionalism were limited. Based on this, this paper proposed that medical colleges and universities should emphasize voluntary service in the cultivation of medical professionalism, especially the development of medical voluntary service activities designed for medical students, and strengthen the cultivation effect by coordinating with other cultivation methods.

Integrating Westward Migration Spirit into the cultivation of medical professionalism / 中华内分泌外科杂志

"Westward Migration Spirit" is the precious spiritual wealth of Chinese Communist Party and the Chinese nation. The course teaching team takes the undergraduate students of clinical medicine as the teaching object, tries to integrate the "Westward Migration Spirit" into the cultivation of medical students’ medical professionalism, so as to endow new connotation of medical professionalism and promote the improvement of medical students’ professionalism. Through literature review, expert consultation and questionnaire survey, the paper sorted out the context of "Westward Migration Spirit" of Chongqing Medical University, and typical examples with the spirit of medical science and humanity were selected and integrated into the teaching. A questionnaire was designed to investigate the evaluation of 425 clinical medicine undergraduates and 5 teachers on the medical professionalism course integrated with "Westward Migration Spirit" . The results show that the students and teachers have good feedback to the medical professionalism courses integrated with the "Westward Migration Spirit" , and the course has a significant positive effect on the cultivation of medical students’ medical professionalism.

17. Coaching and Medical Professionalism Education / 医学教育

Coaching is considered a systematised method of training high-performing athletes and musicians and is characterised by the provision of interpersonal support through interactive dialogue towards set goals. The word “coach” can be traced back to 15th century Europe when the town of Kocs in Hungary produced high-quality four-wheeled carriages that were used in many places, and the word “coach” came to mean a carriage. The word coach is also said to have come to be used to refer to the interpersonal support techniques used to transport important people and their belongings to their destinations. Coaching has since been widely adopted in the business world in Europe and the USA and began to spread in Japan in the late 1990s. In the medical world, literature on coaching has increased since around 2000, and coaching is now used in medical communication, hospital management and medical education. In this series of articles, examples of the introduction of coaching into professionalism education will be introduced from two perspectives: coaching for individuals and coaching for medical teams.

16. Using Humanities and Art to Teach Medical Professionalism / 医学教育

It is said that “medicine is an art based on science,” but education in the art is not well practiced in medical education in Japan compared to education in the science. In a survey of medical students in the U.S., medical students who were exposed to literature, music, theater, visual arts, and other humanities had better empathy, emotional evaluation, and self-efficacy1). Medical humanities education, which is practiced mainly in Europe and the United States, is value education with humanities subjects to overcome dehumanizing medical practices, medical students and medical professionals, and to cultivate professionalism in physicians, such as humanity and altruism. This article focuses on “philosophical dialogue” and “improv” as practical examples of arts education in medicine in Japan that use the humanities and the arts to teach professionalism.

Cinemeducation and Medical Professionalism Education Using Movies to Teach Medical Professionalism / 医学教育

Movie is an artistic activity along with literature, music, painting, and theater. If we consider movie as an art form, we can see it not only as a means of presenting a new way of looking at society, but also as a means of recreating a new sense of common experience. Cinemeducation, the use of film in medical education, has a human development function, i.e., it promotes critical thinking and formation of autonomy, and at the same time, it helps to foster professionalism. For example, it teaches altruism, empathy, and ethical reasoning skills. Specific methods of cinemeducation include the use of whole-length films or movie clips to facilitate small group discussions, asking the learners questions that match the educational objectives, and the combination of role-play, lectures and thinking about medical management or treatment plans. One of the challenges of cinemeducation is the selection of teaching materials, such as what kind of movie to choose, whether to show the whole-length films or just a part of it, and which part to choose, as well as the design of the class content to match the learners' readiness and progress.

Senses and meanings of medical professionalism for gynecology and obstetrics residents / Sentidos e significados de profissionalismo médico para residentes de ginecologia e obstetrícia

Abstract: Introduction: Professionalism is an essential condition for the doctor's performance. The specialty of Gynecology and Obstetrics (GO) has been marked by a growing demand for disciplinary proceedings. Faced with this reality, the American College of Gynecology and Obstetrics (ACOG) recommended recording destructive or hostile behaviors that affect patient safety and the quality of care, remediate them and educate the clinical staff of institutions about it. Despite its importance for the training of future professionals, the lack of consensus about its definition and measurement methods make it difficult to implement targeted actions aimed at this purpose. Objective: This study´s objective was to know the senses and meanings attributed by Gynecology and Obstetrics (GO) residents to medical professionalism. Method: An exploratory, qualitative study was carried out through focal groups with 21 GO residents from Fortaleza, Ceará, Brazil. The analysis of content in the thematic modality supported the data analysis and the interpretation was supported by Symbolic Interactionism. Results: The senses and meanings attributed to professionalism by the residents were expressed in four topics: set of conducts for the benefit of the patient; doctor-patient relationship and relationship with the work team; set of professional attributes; and moral and ethical exercise of the profession. Conclusion: Professionalism is understood as a set of characteristics that include the comprehensive training of the physician, based on skills, scientific knowledge, values, technical skills, clinical reasoning, enabling the exercise of Medicine with respect, morals and ethics.

Resumo: Introdução: Profissionalismo é condição essencial para a atuação do médico. A especialidade de ginecologia e obstetrícia (GO) tem sido marcada por uma demanda crescente de processos disciplinares. Diante dessa realidade, o Colégio Americano de Ginecologia e Obstetrícia (ACOG) recomendou registrar comportamentos destrutivos ou hostis que afetem a segurança do paciente e a qualidade do cuidado, remediá-los e educar o corpo clínico de instituições sobre isso. Apesar da importância do profissionalismo para a formação dos futuros profissionais, a ausência de consenso sobre a definição e os modos de mensuração desse aspecto dificulta a implementação de ações direcionadas voltadas a esse fim. Objetivo: Este estudo teve como objetivo conhecer os sentidos e significados atribuídos pelos residentes de GO ao profissionalismo médico. Método: Realizou-se estudo exploratório, qualitativo, por meio de grupos focais, com 21 residentes de GO de Fortaleza, no Ceará, no Brasil. A análise de conteúdo na modalidade temática respaldou a análise dos dados, e a interpretação amparou-se no interacionismo simbólico. Resultado: Os sentidos e significados atribuídos pelos residentes ao profissionalismo expressaram-se em quatro temáticas: conjunto de condutas em benefício do paciente; relação médico-paciente e com a equipe de trabalho; conjunto de atributos profissionais; e exercício moral e ético da profissão. Conclusão: O profissionalismo é entendido como um conjunto de características que incluem a formação integral do médico, a partir de competências, conhecimentos científicos, valores, habilidades técnicas e raciocínio clínico, possibilitando o exercício da medicina com respeito, moral e ética.

Percepción sobre el profesionalismo médico en estudiantes del último año de medicina en una universidad peruana / Perception of medical professionalism in students of the last year of their career in a Peruvian university

RESUMEN Objetivo: Describir conceptos, experiencias y perspectivas que alumnos del último año de medicina en una universidad peruana tienen respecto al Profesionalismo Médico. Material y Métodos : Se aplicó una encuesta a alumnos que cursaban la rotación clínica final de su último (7º) año de estudios en la Facultad de Medicina de la Universidad Peruana Cayetano Heredia, durante el año 2015. Resultados : El porcentaje de respuestas fue 90,5%. Las tres respuestas más comunes fueron ética (51,2%), buena comunicación médico-paciente (43%) y conocimientos (41,9%). El 81,4 % de los estudiantes estuvo "de acuerdo" o "muy de acuerdo" con el hecho de que profesionalismo puede ser aprendido y enseñado. El contacto con modelos positivos del personal docente de la Facultad (4,26/5,00) fue considerado el método más útil para el aprendizaje sobre profesionalismo médico, en tanto que sólo el 25,6% consideró adecuado el número de actividades dedicadas a la enseñanza del tema. Conclusiones: Los Internos de medicina consideran a la ética, una buena relación médico-paciente, conocimiento, respeto y responsabilidad como principales atributos del profesionalismo médico. Percibieron que su concepto de profesionalismo fue más influenciado por modelos positivos que por actividades académicas formales.

SUMMARY Objective : To describe concepts, experiences, and perspectives from senior (7th Year) medical students of a Peruvian university, regarding Medical Professionalism. Material and Methods : A survey was applied to medical students that completed their Internship at the Faculty of Medicine of the Universidad Peruana Cayetano Heredia, during 2015. Results : The percentage of responses reached a 90.5%. The three most common responses were ethics (51.2%), a good doctor-patient relationship (43%), and knowledge (41.9%). Approximately eighty-one percent (81.4%) of the students "agreed" or "strongly agreed" with the fact that professionalism can be learned and taught. The contact with positive models from the faculty (4.26 / 5.00) was considered as the most useful method for learning about professionalism, while only 25.6% considered adequate the number of activities dedicated to the teaching of the topic. Conclusions: Medical interns consider ethics, good patient-physician communication, knowledge, respect and responsibility as the main attributes of medical professionalism. They perceived that their concept of professionalism was more influenced by positive faculty models than by formal academic activities.

Exploration and practice of applying discussion-based film and television appreciation to the cultivation of medical professionalism / 中华医学教育探索杂志

In view of the lack of teaching methods in the cultivation of medical professionalism, this paper puts forward some important strategies for improving medical students' professionalism through discussion-based film and television appreciation. High-quality discussion-based film and television appreciation can be designed according to the four links of film selection, concentrated viewing, independent discussion and summary feedback. At the same time, in practice, attention should be paid to three key issues: selecting appropriate films, ensuring the quality and depth of discussion, and paying attention to feedback and evaluation. Practice has proved that discussion-based film and television appreciation makes the cultivation of professionalism more attractive, and can promote the professional knowledge and professional spirit, enhance students' professional enthusiasm, promote the understanding of the connotation of professionalism and reflection on related issues. Medical colleges should continue to improve the design of film viewing in practice, so as to help students better absorb humanistic nutrients from the discussion and enhance the teaching effect of professionalism.

The connotation and development of medical professionalism in the new era / 中华医学教育探索杂志

Medical professionalism plays a critical role in training doctors with noble medical ethics and excellent medical skills. Clarifying the connotation of medical professionalism is the only way which must be passed to deepen the research and cultivation of medical professionalism. At present, there is a heated discussion on the medical professionalism in the world. This study will introduce the development history and latest research progress of medical professionalism and summarize the evolution track and characteristics of medical professionalism from three aspects: development period, international authorities' explanations and research framework. Furthermore, this study will also discuss the connotation and development of medical professionalism in the new era of China, in order to provide reference for the cultivation and evaluation of medical professionalism.

Profesionalismo médico en la formación de los estudiantes de medicina / Medical professionalism in the training of medicine students

The transformations experienced by the society have strongly impacted the role of the medical profession in the world. Various factors such as technological progress and knowledge, globalization, massive access to information, market, policy and health systems determine a new and changing scenario for the practice of medicine. For several decades, there has been a growing concern from various medical schools worldwide to strengthen the teaching of medical students on contents related to professionalism, in order to prepare more efficiently future doctors, to successfully face the challenge to develop in this new context without abandoning the principles of hippocratic medicine, which for centuries have guided the exercise of the profession in the West. Although there are different interpretations and definitions for medical professionalism, there is consensus that involves humanitarian attitudes and behaviors that complement scientific and technical formation of excellence, which is framed in ethics and privilege above all the patients' welfare. Literature reviewed makes reference to various proposals to approach teaching and curricular introduction of medical professionalism. Most researchers raise the need to incorporate medical professionalism transversely in the curriculum using a variety of methodologies at both undergraduate and postgraduate level.

El "paciente difícil" y profesionalismo médico / The "difficult patient" and medical professionalism

En el presente artículo se revisan las características que definen al "paciente difícil" entendiendo que esta realidad se comprende mejor como una "relación difícil médico-paciente". Bajo una mirada antropológica se repasan las bases que componen el encuentro entre el médico y un paciente, para transmitir algunas recomendaciones sobre cómo mejorar este singular encuentro, a fin de que se genere una mayor satisfacción y beneficio para ambos. Surge como recomendación considerar los elementos constitutivos del profesionalismo médico, teniendo especialmente presente la autonomía del paciente, la primacía del bienestar del mismo y una actitud de servicio y compasión por el enfermo, por parte del médico. Si a ello se une el esfuerzo por una mirada empática, se puede esperar una mejor relación entre este binomio.

This article reviews the features that characterize the "difficult patient", which is a concept defined on the basis of a "difficult physician-patient relationship". It reviews the fundamentals of the physician-patient relationship from an anthropological point of view and provides recommendations to improve it in a way that it is more beneficial and provides greater satisfaction for both parties. The article suggests physician should seek to achieve high levels of medical professionalism by respecting the patient's autonomy and seeking her well-being at all times, while showing compassion and a service attitude towards her. In addition to this, a more empathetic attitude towards the patient can also contribute to improving the relationship.

Korean medical students' attitudes toward academic misconduct: a cross-sectional multicenter study / 한국의학교육

PURPOSE: This study investigated medical students' attitudes toward academic misconduct that occurs in the learning environment during the pre-clinical and clinical periods. METHODS: Third-year medical students from seven medical schools were invited to participate in this study. A total of 337 of the 557 (60.5%) students completed an inventory assessing their attitudes toward academic misconduct. The inventory covered seven factors: scientific misconduct (eight items), irresponsibility in class (six items), disrespectful behavior in patient care (five items), dishonesty in clerkship tasks (four items), free riding on group assignments (four items), irresponsibility during clerkship (two items), and cheating on examinations (one item). RESULTS: Medical students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. There was no difference in students' attitudes toward unprofessional behaviors by gender. The graduate medical school students showed a stricter attitude toward some factors of academic misconduct than the medical college students. This difference was significant for irresponsibility in class, disrespectful behavior in patient care, and free riding on group assignments. CONCLUSION: This study indicates a critical vulnerability in medical students' professionalism toward academic integrity and responsibility. Further study evidence is needed to confirm whether this professionalism lapse is confined only to this population or is pervasive in other medical schools as well.

Science of Morality as the Bases for Understanding Medical Professionalism / 医学教育

Professionalism is the (right) way of being/doing things as a member of a particular profession. Evaluating legitimacy (right/wrong) of one’s behavior or the behavior of others is a moral judgement. Thus, professionalism is a set of desirable moral characteristics of a particular profession. The education of professionalism firstly promotes learning a set of desirable moral characteristics required in a profession. Secondly, it promotes the resolution of conflict with someone who has different moral characteristics. In this article, a possible learning strategy to promote these learning objectives will be explained based on the emerging knowledge of the science of human morality.

Patient-Centeredness during In-Depth Consultation in the Outpatient Clinic of a Tertiary Hospital in Korea: Paradigm Shift from Disease to Patient

BACKGROUND: Patient-centered care (PCC) and integrative care approach are widely advocated. However, their implementation usually requires an extended consultation time. Despite significant advances in medical diagnosis and treatment, no studies have examined consultation time and patient centeredness in Korea. METHODS: We conducted a “15-Minute Consultation” for first-time patients in outpatient clinics of 13 departments. A control group was selected from the same physicians' first-time patients, adjusting for age and gender. A total of 275 patients were selected for receiving in-depth consultation and 141 control patients were selected for regular consultation. Data were collected from patients using a questionnaire comprising a patient-centeredness scale and items on potential predictors such as socio-demographic and clinical factors. We also investigated the participating physician's professionalism. RESULTS: As compared to the control group, the in-depth consultation group scored higher on 5 variables associated with PCC, including (patients' perception of) medical professionals, wait and consultation times, treatment, patient advocacy, and patient satisfaction. While 92.4% of patients in the in-depth consultation group reported that the consultation time was sufficient, only 69.0% of those in the control group reported the same (P < 0.01). In the in-depth consultation group, scores on satisfaction level were the highest for the department of internal medicine, followed by departments of surgery and pediatrics. Participating physicians' improved satisfaction following the intervention proved that in-depth consultation facilitated building a rapport with patients. CONCLUSION: This study illustrated that the provision of sufficiently long consultation for serious and rare diseases could improve PCC and physicians' professionalism. Health authorities should reshuffle the healthcare delivery system and provide sufficient consultation time to ensure PCC and medical professionalism.

Medical Professionalism and Self-Reflection in Medical Education / 의학교육논단

Recently, unprofessional behavior by physicians and misconduct by medical students have led to increased public concern over medical professionalism. Many studies have been conducted to explore strategies that reinforce professionalism education and prevent misconduct in medical students. However, most studies focused on defining the medical professionalism and its conceptual components. In this study, we conducted a conceptual analysis based on the literature review to categorize issues of unprofessional behavior, and identified doctors' indifference to self and others as the reason for the unprofessional behavior. In this regard, self-reflection provides a practical tool to overcome such indifference. We suggest ‘education and evaluation based on self-reflection and reflective practices’ as the effective strategies to enhance the professionalism in medical students.

Doctor's images in the Korean medical drama viewed from the perspective of Medical Professionalism / 의료커뮤니케이션

BACKGROUND: TV dramas can affect the identity of a person or group that the public perceives by presenting virtualized characters and events. The image of a doctor in the medical drama can influence the identity of a contemporary physician group. The authors analyze several medical dramas in Korea from the viewpoint of medical professionalism and try to contribute to the enlightment of the image of the doctor.METHODS: Among the medical dramas that have been broadcast since medical professions began to appear, 5 dramas were selected for analysis. The author reviewed them by four major areas of medical professionalism: contribution to society, compliance with the four principles of medical ethics, professional autonomy, and recognition from society and scored an upper-middle-lower grade.RESULTS: ‘Contribution to society’ and ‘recognition from society’ were well-founded in all dramas, except ‘Doctor Stranger’. In the case of ‘compliance with the four principles of medical ethics’, ‘Golden Time’ and ‘Romantic doctors Kim’ most frequently violated it. The ‘medical ethics principle’ was frequently infringed on ‘Doctor Strangers’, In the case of ‘Doctors’, the violation of the ethics principle was reduced as the conflict between the drama characters were emphasized. ‘Professional autonomy’ is best demonstrated by stubborn doctors appearing in ‘Golden Time’ and ‘Romantic Doctors Kim’.CONCLUSION: It is necessary to criticize the doctors image in the current drama from the view point of the medical professionalism and to continue to teach the drama writer about medical professionalism.

Medical Professionalism: the Effects of Sociodemographic Diversity and Curricular Organization on the Attitudinal Performance of Medical Students / Profissionalismo Médico: Efeito da Diversidade Sociodemográfica e da Organização Curricular no Desempenho Atitudinal dos Estudantes de Medicina

ABSTRACT Introduction: Socioeconomic and demographic diversity in the educational environment and the development of professional attitudes enhance the quality of health care delivery. Despite the importance of diversity for equity and accessibility to health care, its repercussions for students' attitudinal learning have not been adequately evaluated. Purpose: Evaluate the influence of academic sociodemographic diversity and curricular organization in the development of professional attitudes in different phases of the undergraduate medical curriculum. Method: In 2012, the attitudinal performance of 310 socioeconomically diverse medical students was evaluated by the administration of a five-point professional attitudes scale. The participants were at different points in their education at a Brazilian public school of medicine in Brasília, Federal District. The scale comprised 6 factors: communication, ethics, professional excellence, self-assessment, beliefs, social determinants; and a general factor called medical professionalism and was validated for the purpose of this research. The reliability coefficients (aCronbach) ranged from 0.65 to 0.87, according to different scale dimensions. Student diversity was analyzed according to differences in gender, age, religious affiliation, system of student selection and socioeconomic background. Results: The authors observed a decline in the mean attitude scores during the clinical phase compared to the preclinical phase of the curriculum. Female students displayed more positive attitudes than male students, and the students who declared a religious affiliation recorded higher attitude scores compared to those who declared themselves atheist, agnostic or non-religious. There was no correlation between family income or the system of student selection and the students' attitude scores. The students who had attended public schools expressed a greater interest in working in the public health system compared to the other students. Age and marital status had no relevant effect on attitude scores. Conclusions: The attitude scores of medical students declined as the curriculum progressed. Female students had more positive attitudes than male students. Religious affiliation appeared to positively influence the observed attitude scores.

RESUMO Introdução: A diversidade socioeconômica e demográfica no ambiente educacional e o desenvolvimento de attitudes profissionais estão associados ao aumento na qualidade da assistência em saúde. Apesar da importância dessa diversidade para a equidade e acessibilidade ao sistema de saúde, sua repercussão no aprendizado atitudinal dos estudantes em nosso meio ainda é muito pouco estudada e avaliada. Objetivo: Avaliar a influência das diferenças demográficas, sociais e económicas e da organização curricular no desempenho atitudinal de estudantes de graduação em Medicina em diferentes fases do curso. Método: Em 2012, o desempenho atitudinal de 310 estudantes de Medicina foi avaliado mediante a aplicação de uma escala de atitudes profissionais de cinco pontos. Os participantes eram de diferentes séries do curso de graduação em Medicina de uma escola pública de Medicina de Brasília (DF). A escala de atitudes utilizada era composta por seis fatores — Comunicação; Ética; Excelência Profissional; Autoavaliação; Crenças; Determinantes Sociais; e um fator geral chamado Profissionalismo Médico — e foi validada para as finalidades desta pesquisa. O coeficiente de fidedignidade (a de Cronbach) para as diferentes dimensões da escala variou de 0,65 a 0,87. A diversidade dos estudantes foi avaliada de acordo com gênero, idade, religião, sistema de ingresso no curso (cotistas sociais/não cotistas) e condições socioeconómicas. Resultados: Os autores observaram um declínio nos escores médios de atitude em várias dimensões da escala durante a fase clínica, comparada à fase pré-clínica do currículo. Estudantes do gênero feminino obtiveram escores de atitudes mais positivos do que os do gênero masculino. Estudantes que declararam ter uma religião tiveram melhores escores do que os que se declararam ateus, agnósticos ou sem religião. Não houve correlação entre idade, estado civil e renda familiar e o desempenho atitudinal medido pela escala. Estudantes que ingressaram no curso pelo sistema de cotas expressaram maior interesse em trabalhar no sistema público de saúde. Conclusões: Houve um declínio do escore de atitude dos estudantes de Medicina com a progressão do curso. Estudantes do gênero feminino apresentaram escores de atitudes mais positivos que os do gênero masculino. Filiação religiosa parece influenciar positivamente o desempenho atitudinal dos estudantes.

Profesionalidad médica en el capitalismo tardío: percepciones de estudiantes de medicina de la Universidad de Chile / Medical professionalism in late capitalism: perceptions of the medical students at Universidad de Chile

Introducción. La profesionalidad médica está en crisis por la transición desde el libre ejercicio a ser empleados de corporaciones que manejan todo lo relacionado con salud con criterios correspondientes al modelo socioeconómico imperante, permeando la conceptualización y prácticas del ejercicio profesional. Objetivos. Describir cómo los estudiantes de medicina perciben su profesionalidad, identificando factores contextuales que la modulan e implicaciones sobre su vida profesional y personal. Diseño. Investigación cualitativa enmarcada en un estudio del aporte del internado rural a la formación médica. Participantes. Estudiantes del último año de la carrera de medicina. Lugar. Facultad de Medicina, Universidad de Chile. Intervenciones. Se realizaron quince entrevistas semiestructuradas a estudiantes del último año de la carrera en medicina, aplicando análisis narrativo de contenidos e interpretación de significados. Principales medidas de resultados. Percepción de su profesionalidad. Resultados. Existió fuerte tensión entre los valores y principios del ejercicio de la profesión médica y los condicionantes institucionales y contextuales de su práctica. Los entrevistados asumieron responsablemente la búsqueda de soluciones para los motivos de consulta de sus pacientes, desarrollando estrategias individuales orientadas a vencer las limitaciones del sistema y manejar la frustración experimentada. Conclusiones. Conocer cómo los futuros médicos viven e intentan sobrellevar las contradicciones entre su profesionalidad y la realidad laboral evidencia la necesidad de modificar la formación médica. Se propone que lo colectivo se convierta en sustrato y mecanismo de este cambio.

Introduction: Medical professionalism is facing a crisis due to the transition from liberal practice to becoming employees of corporations that manage health related issues with criteria corresponding to the prevailing socioeconomic model which also influences medical concepts and practices. Objectives/: To describe how medical students perceive their professionalism; to identify influencing contextual factors and to portray their implications in student's lives and professional performance. Design: Qualitative research framed in a study regarding the contribution of the rural internship to the medical undergraduate program. Participants: Last year students of medical school. Setting. Faculty of Medicine, Universidad de Chile. Interventions. Fifteen semi-structured interviews were performed to students in their last year at medical school. Narrative analysis followed by interpretation of its meaning was applied to the resulting information. Main outcome measures: Perception of professionalism. Results: Strong tension exists between professionalism's core principles and values and institutional and contextual factors shaping current medical practice. Interviewees take their duty to respond to patient's demands and needs with high sense of responsibility, developing individual strategies to overcome system's limitations and cope with arising frustrations. Conclusions: Evidence on how medical students perceive and try to cope with these contradictions poses the need for a profound transformation of medical education. Focusing on the collective is proposed as a conceptual base as well as a key mechanism for this change.