Understanding of professionalism among medical students in the first year of the COVID-19 pandemic - a qualitative monocentric study.

Objective: The existing literature indicates that medical students' understanding of professionalism is influenced by internal and external factors. Therefore, this study aimed to evaluate whether the early phase of the pandemic affected the understanding of professionalism among medical students at the University of Ulm. Methods: In May and June 2020, semi-structured telephone interviews were conducted with 21 students (in the 8th and 9th semester) at the Medical Faculty of the University of Ulm. The interviews were transcribed and analyzed by a qualitative content analysis according to Mayring. Results: The results showed shifts in students' perception of the importance of certain aspects of medical professionalism. Not only competency in the disciplines hygiene, virology, and microbiology came to the fore, but also personal qualities such as "radiating a sense of calm", empathy, and altruism; communicative competency; and the capacity for reflection. The students also perceived changes in the expectations placed on them. More emphasis was placed on their roles as scientific or medical advisors and as helpers in the health care system, a change that was sometimes emotionally stressful. With respect to the study objective, both limiting and supporting factors were named. For example, the clarification of the relevance of the medical professional was motivating. Conclusion: The study showed that students' understanding of professionalism depends on context, as was suggested by earlier studies in experts. The perception of changed role expectations may thereby also play a role. One consequence of the findings may be to address such dynamics in suitable curricular events and discuss them with students to prevent them proceeding in an uncontrolled manner.

Professionalism in small group learning between face-to-face and virtual settings: a mixed-methods study.

Objectives: To explore whether and how preclinical medical students changed perceptions and behaviors related to professionalism in small group learning activities from face-to-face to virtual during the pandemic. Methods: The study used a mixed-methods sequential research design. We first retrospectively examined quantitative data from 101 medical students who completed mandatory peer evaluation surveys assessing professional behaviors of small group members in two courses (one face-to-face, the other online). Differences between student perceptions in two settings were compared using the Wilcoxon signed-rank test. Findings from the quantitative stage were probed further using focus groups at the qualitative stage. Six focus groups (n = 27) were conducted using purposeful sampling. Interviews were transcribed and inductive thematic coding was used to identify emerging themes. Results: We found a significant decrease in perceptions of punctuality and attendance in the virtual setting compared to face-to-face learning (Z=-6.211, p<.001), despite lower expectations of their peers in online learning. Five major themes emerged from the qualitative data: punctuality/participation, camera usage, dress code/conversational style, multitasking, and engagement/accountability. Participants showed sensitivity when conceptualizing professional conduct, indicating the dynamic process of professional identity formation at the early stage of their career. Conclusions: Results show that students' perceptions of professionalism become contextualized, significantly influenced by the background of the virtual learning environment. Intentional communication about professionalism within specific sociocultural and educational contexts is vital for individual professional identity formation. These findings support of the importance of considering context when educational programs develop curricula and establish expectations related to professionalism.

[Challenges for training medical professionalism values in times of COVID-19 and social crisis]. / Desafíos en la formación de los valores del profesionalismo médico en tiempos del COVID-19 y de crisis social.

The essence of professional education not only involves transmitting knowledge, but also values and attitudes for a practice that allows us to face changing global and national scenarios. Physicians are currently facing new challenges derived from the impacts of the pandemic as well as the social crisis. Increased workload, limited access to health systems, economic uncertainty, and increased public scrutiny hamper physicians to fulfill their responsibilities to patients and society. Likewise, digital learning and few opportunities for face-to-face practice during the pandemic abruptly altered the training process for students and residents. In this essay, teaching of medical professionalism and its values is reviewed, considering the challenges posed by new social and healthcare contexts fort the future professional behavior. This commitment, however, requires not only ethical values but also humanism and social commitment. Medical professionalism acts as a stabilizing and morally protective social force. Thus, it is critical to fathom essential values of professionalism that characterize medical practice today. Indeed, the explicit incorporation of these values in undergraduate and postgraduate programs will undoubtedly allow the training of better professionals for the practice of medicine. (Rev Med Chile 2022; 150: 1248-1255).

The Role of the Advanced Practice Provider in a Subspecialty Practice: Satisfaction and Professionalism, Including COVID-19 Impacts.

The advanced practice provider collaborates with other clinicians and works to educate, advocate, and increase access for patients in the clinical setting. Research has shown that advanced practice providers working collaboratively with physicians yield improved quality of care and outcomes; however, the current level of understanding of this role in gastroenterology has not been explored in detail. Across two academic institutions, we conducted 16 semi-structured interviews to examine how the environment of the gastroenterology department aligns with the professional satisfaction of its advanced practice providers. Thematic saturation was achieved, revealing four themes: (1) productivity of the working relationship; (2) inconsistent understandings of the advanced practice provider role in clinical care; (3) mixed advanced practice provider experience relating to colleague support; and (4) autonomy impacts satisfaction. These themes highlight not only a reasonable degree of advanced practice provider satisfaction, but also the need to engage with colleagues regarding the advanced practice provider role in care to allow for better integration into the overall gastroenterology healthcare team. The results from different institutions suggest the need to interview gastroenterology advanced practice providers in different settings to better understand whether similar themes exist.

Obligation or getaway? A qualitative inquiry into medical professionalism under COVID-19 among medical students and new physicians in a Taiwan hospital.

OBJECTIVES: During the COVID-19 outbreak, medical educators' main concern has been how to prepare new physicians and medical students to meet their obligations as healthcare providers under novel circumstances. This study aims at exploring how trainees perceive their commitments as physicians under the threat of a pandemic. DESIGN: A qualitative method was employed. Researchers interviewed medical students under clerkship training (fifth and sixth-year medical students) and new physicians undergoing postgraduate year (PGY) and specialty training. SETTING: A university hospital in Taipei, Taiwan. PARTICIPANTS: The team conducted three focus groups for participants in three separate training stages: clerks, PGY students (PGYs), and residents. Researchers collected data from 31 March to 2 April 2020 and analysed the thematic analysis results. RESULTS: Seventeen medical students and new physicians took part in the focus groups, five of whom (31.25%) were female. Participants consisted of four residents, six PGYs, and seven medical students. Through their responses, the authors determined four major dimensions with corresponding subdimensions that significantly affected their sense of medical professionalism, including medical knowledge and clinical skills, sense of duty towards public health, teamwork and protection of patient rights. CONCLUSIONS: We therefore concluded that participants grew to accept their roles after acquiring the knowledge and skills needed to care for patients with COVID-19. Alternative teaching arrangements and their impact on trainees' clinical performance require further discussion.

Oncological big data platforms for promoting digital competencies and professionalism in Chinese medical students: a cross-sectional study.

OBJECTIVES: Advancements in big data technology are reshaping the healthcare system in China. This study aims to explore the role of medical big data in promoting digital competencies and professionalism among Chinese medical students. DESIGN, SETTING AND PARTICIPANTS: This study was conducted among 274 medical students who attended a workshop on medical big data conducted on 8 July 2021 in Tongji Hospital. The workshop was based on the first nationwide multifunction gynecologic oncology medical big data platform in China, at the National Union of Real-World Gynecologic Oncology Research & Patient Management Platform (NUWA platform). OUTCOME MEASURES: Data on knowledge, attitudes towards big data technology and professionalism were collected before and after the workshop. We have measured the four skill categories: doctor‒patient relationship skills, reflective skills, time management and interprofessional relationship skills using the Professionalism Mini-Evaluation Exercise (P-MEX) as a reflection for professionalism. RESULTS: A total of 274 students participated in this workshop and completed all the surveys. Before the workshop, only 27% of them knew the detailed content of medical big data platforms, and 64% knew the potential application of medical big data. The majority of the students believed that big data technology is practical in their clinical practice (77%), medical education (85%) and scientific research (82%). Over 80% of the participants showed positive attitudes toward big data platforms. They also exhibited sufficient professionalism before the workshop. Meanwhile, the workshop significantly promoted students' knowledge of medical big data (p<0.05), and led to more positive attitudes towards big data platforms and higher levels of professionalism. CONCLUSIONS: Chinese medical students have primitive acquaintance and positive attitudes toward big data technology. The NUWA platform-based workshop may potentially promote their understanding of big data and enhance professionalism, according to the self-measured P-MEX scale.

The moderating effect of burnout on professionalism, values and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modelling approach.

AIM: To examine the moderating effect of burnout on the relationship between nurses' competence, professional competence and professional values. BACKGROUND: There is a preponderance of burnout studies of nurses before and during the COVID-19 pandemic. However, little is known about burnout's moderating influence on nurses' professionalism, competence and values during the ongoing pandemic. METHODS: This study used a correlational, cross-sectional design and convenience sampling to recruit 809 Saudi nurses employed in four government hospitals. Four self-report instruments were used to collect data from August 2021 to March 2022. Spearman Rho, structural equation modelling and multi-group moderation analysis were used to analyse the data. RESULTS: Most of the participants had high burnout. There was a moderate to high correlation between the dimensions of professional competence, nurse professional values, burnout and nurse competence. Both professional competence and nurse professional values significantly affected nurse competence. Nurse professional values also had a direct effect on professional competence. Professional competence and nurse professional values on nurse competence may vary among those with low, moderate and high levels of burnout, suggesting the moderating effect of burnout. CONCLUSIONS: The positive impacts of nurse professional values and professional competence on nursing competence were validated in this study, as was the evidence of burnout's moderating effect on the studied connections. To avoid burnout, it is necessary to increase organizational knowledge and support for nurses, their working conditions and the environment through strategies that promote well-being and empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can implement policies to help nurses minimize burnout and improve their professional values and competence. Management policies may be considered include increased staffing, opportunities to improve technical abilities through education and vocational training programs, and increased diversity of job assignments.

The evolving role of digital media in medical education.

Within the last decade, social media has progressed from a form of mere entertainment to a medium for solution of complex issues in our daily lives. During the last few years, social media has gained value in medical education and the diversity in the use of digital media has given new dimensions to medical education while facing the Covid pandemic. Digital media helps in creating virtual communities which not only bring more harmony between teachers and students but has also shown to have reduced anxiety and stress among students. Common social media platforms such as Facebook and WhatsApp have recently gained popularity as platforms which are being actively used in various ways to enhance learning. Social media in medical education is also utilised to enhance communication skills, professionalism and better patient care, but this should be addressed with caution as violation of patient's privacy and confidentiality remains a threat.

Assessment of safety attitudes, professionalism and exploration of medical students' experiences.

BACKGROUND: The present study was conducted to examine the interns' perceptions of safety attitude and professionalism and to explore their experiences about adherence to the principles during the COVID-19 pandemic. METHOD: The present study was a mixed-method that was performed in two quantitative and qualitative stages. The medical interns at X University (n = 140) were entered. In the quantitative phase, the assessment of the interns' Safety Attitudes and Professionalism was conducted by a survey. In the qualitative phase, data were gathered by semi-structured interviews. The experiences of participants were analyzed by the inductive content analysis approach of Graneheim and Lundman. RESULTS: Participants' perception scores on safety attitude and professionalism were 98.02 (14.78). The results were explained in a theme of "weakness in systemic accountability in compliance with professionalism and safety". The theme included three categories: 'support system inadequacy', and 'null curriculum in safety and professionalism education'. CONCLUSION: The present results showed participants' perception scores on safety attitude and professionalism were below the moderate level. The systemic issues were explored as influencing factors in the occurrence of unsafe and unprofessional behaviors. They reported the weakness of the support system (individual, teamwork, mental health, well-being, management, and culture), and the null curriculum in education of professional, and safety principles effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, it is recommended to create mechanisms to support the development of professionalism of healthcare workers, especially, novice providers and students, and pay attention to the safety and professionalism in formal and informal educational programs.

Role of Empathy and Lifelong Learning Abilities in Physicians and Nurses Who Work in Direct Contact with Patients in Adverse Working Conditions.

Empathy and lifelong learning are two professional competencies that depend on the four principles of professionalism: humanism, altruism, excellence, and accountability. In occupational health, there is evidence that empathy prevents work distress. However, in the case of lifelong learning, the evidence is still scarce. In addition, recent studies suggest that the development of lifelong learning varies in physicians and nurses and that it is sensitive to the influence of cultural stereotypes associated with professional roles. This study was performed with the purpose of determining the specific role that empathy and lifelong learning play in the reduction in occupational stress. This study included a sample composed by 40 physicians and 40 nurses with high dedication to clinical work in ambulatory consultations from a public healthcare institution in Paraguay. Somatization, exhaustion, and work alienation, described as indicators of occupational stress, were used as dependent variables, whereas empathy, lifelong learning, gender, discipline, professional experience, civil status, and family burden were used as potential predictors. Three multiple regression models explained 32% of the variability of somatization based on a linear relationship with empathy, lifelong learning, and civil status; 73% of the variability of exhaustion based on a linear relationship with empathy, somatization, work alienation, and discipline; and 62% of the variability of work alienation based on a linear relationship with lifelong learning, exhaustion, and discipline. These findings indicate that empathy and lifelong learning play important roles in the prevention of work distress in physicians and nurses. However, this role varies by discipline.

Psychosocial Experiences of Front-Line Nurses Working During the COVID-19 Pandemic in Hubei, China: A Qualitative Study.

BACKGROUND: A large number of nurses across China joined the anti-coronavirus disease 2019 (COVID-19) front-line in Hubei province, where the local healthcare system faced unprecedented challenges in the early 2020. Few studies have reported the psychological experiences of nurses from other regions who voluntarily participated in the response to the COVID-19 pandemic in Hubei province. AIM: To describe the psychological experiences of nurses who were involved in the anti-COVID-19 pandemic battle in Hubei province from January to April 2020. METHODS: This was a qualitative descriptive study using purposive and snowball sampling strategies for participant recruitment. Twenty-four nurses were approached and twenty-one of them completed telephone interviews in April 2020. The interviews took an average of 75 min (range 34-140 min). Data were analyzed thematically after verbatim transcription of the interviews. RESULTS: Our analysis generated three primary themes: (I) Contexts; (II) Psychological responses; and (III) Coping strategies (most participants identified suitable coping strategies including relaxing activities and seeking social support). Participants' psychological responses varied in four phases of the journey through the experience: (i) initiation phase: obligations and concerns/fears; (ii) transition phase: from overwhelmed to increased confidence; (iii) adaptation phase: a sense of achievement and exhaustion; and (iv) completion phase: professional and personal growth. CONCLUSION: Nurses had concerns, fears, and faced challenges working on the COVID-19 front-line. However, they were motivated by a strong sense of professional commitment. Most nurses successfully achieved personal and professional growth as they identified a range of coping strategies. Future research is needed to explore the long-term impact of the COVID-19 related working experiences on these nurses.

We Thank You: Now Let's Work Together to Enact Change.

The omicron variant of the SARS-CoV-2 virus continues to overwhelm healthcare systems. The anticipated temporary disruption of the COVID-19 pandemic is now in its third year. Across multiple settings, nurses have continued to provide direct care, lead in healthcare organizations and political arenas, conduct research, and teach the next generation of nurses amid a novel virus and politicization of the healthcare infrastructure that has led to enmity toward healthcare providers. This editorial focuses on the next steps for demonstrating gratitude for the nurses who have persisted, continuing to do their jobs and honoring their professional creed in conditions that have extracted personal, professional and, for some, moral costs.

Professionalism: COVID-19 made me do it!

PURPOSE OF REVIEW: COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct. RECENT FINDINGS: Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic. SUMMARY: There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.

Factors influencing nurses' intention to care for patients with COVID-19: Focusing on positive psychological capital and nursing professionalism.

PURPOSE: It is necessary to identify factors that influence nurses' intention to care for coronavirus disease 2019 (COVID-19) patients to improve the quality of care during the pandemic. This study identifies factors that influence nurses' intention to care for COVID-19 patients, focusing on positive psychological capital and nursing professionalism. METHODS: This study adopted a descriptive correlational design. Data were collected between August 16 and August 30, 2020, through self-administered questionnaires from 148 bedside nurses caring for COVID-19 patients, from four hospitals designated for COVID-19 treatment. Modified versions of the Nursing Intention Questionnaire for SARS Patient Care, Psychological Capital Questionnaire, and Hall's Professional Inventory were used. The collected data were analyzed using stepwise multiple regression. RESULTS: In total, 165 questionnaires were distributed, and 148 questionnaires (89.7%) were included in the final analysis. Factors influencing nurses' intention to care were: age (30<: ß = .18, p = .026; ≥50: ß = .23, p = .005), department (ICU: ß = -.26, p = .001), sufficient clinical experience and skills to care for COVID-19 patients (sufficient: ß = .18, p = .019), and positive psychological capital (ß = .22, p = .044). The model's explanatory power (R2) was 48%. CONCLUSIONS: Strategies to increase nurses' positive psychological capital are necessary to improve nursing care quality by increasing intention to care when facing novel infectious diseases such as COVID-19. Furthermore, adequate education and training on managing novel infectious diseases should be implemented to provide nurses with relevant experience and skills regarding caring for patients infected with these diseases. Through various studies, strategies for improving nurses' positive psychological capital need to be suggested to improve the quality of care by increasing the nurses' intention to care during the emergence of a novel infectious disease, such as COVID-19. Additionally, adequate education and training on managing the novel infectious diseases, sufficient for the nurses to believe they have the experience and skills for caring for the infected patients, will be needed.

[Factors Influencing Nurses' Performance of Care in COVID-19 Wards].

PURPOSE: The purpose of this study was to identify factors influencing nurses' performance of care in COVID-19 wards. METHODS: The participants were 132 nurses who worked in COVID-19 wards at three hospitals, and were recruited from April 1 to May 31, 2021. Data were analyzed using descriptive statistics, t-test, ANOVA, and multiple regression analysis with SPSS/WIN 24.0 program. RESULTS: Nursing performance was significantly and positively correlated with ethical sensitivity (r = .75, p < .001), nursing professionalism (r = .67, p < .001), and social support (r = .67, p < .001). Nursing professionalism was positively correlated with ethical sensitivity (r = .64, p < .001) and social support (r = .55, p < .001). Multiple regression analysis for nursing performance revealed that the most significant factor was ethical sensitivity (ß = .47, p < .001). Ethical sensitivity, nursing professionalism, and social support explained 66.0% of total variance in nursing performance. CONCLUSION: Ethical sensitiviy, nursing professionalism, and social support significantly influence nurses' performace of care in COVID-19 wards. It suggests that intervention programs should be directed at improving nurses' ethical sensitivity, bolstering social support, and enhancing nursing professionalism.