Pretoria Medical Students' Perspectives on Assessable Attributes of Professionalism

Background : Professionalism forms an important aspect of medicine's contract with society; and it is therefore important that it should be assessed and developed in medical schools. For the effective assessment of medical students' professionalism; clear objectives; or outcomes based on a clear definition of professionalism; have to be accepted by society; the faculty and the students. A Physician's Charter; 'Medical Professionalism in the New Millennium???; was published by the Annals of Internal Medicine in February 2002. Fifth-year medical students of the University of Pretoria were challenged to comment on the applicability of this Charter's principles and responsibilities in the South African context. The majority of the students did not fully agree with the principles and responsibilities. A following cohort of fifth-year students was requested to define professionalism and describe attributes that could be included in an assessment tool. Methods : A qualitative design was employed to explore the students' perceptions. An analysis of the scripts was performed using qualitative content analysis. All the scripts were read twice and the emergent themes (attributes of professionalism) were identified by two researchers. The scripts were reviewed and coded independently to enhance reliability. Investigator triangulation; involving researchers with diverse research backgrounds; was done to validate the identified attributes. The themes were organised into categories (domains of professionalism). The authors discussed differing concepts with the other members of the Professional Attitude Development and Assessment Committee (PADAC) to arrive at a consensus. In the second stage of analysis; the identified themes were compared to the Charter. This was supported by quotations taken from the students' perceptions; as well as from the relevant literature. Tabulations were used to determine the frequencies of the different themes.ResultsThe attributes used to describe professionalism were grouped under four main domains: attitude and personal conduct; teamwork; patient care and professional competence. These correspond; to some extent; with the Charter. Most of the students; however; stressed the humanistic attributes of professional behaviour; which are not mentioned in the Charter. These attributes include empathy; interpersonal relationships; integrity; respect; maturity and teamwork.Conclusion : The students' perceptions of professionalism differed from that described in the Charter. The fact that the students value the humanistic part of professionalism could possibly be ascribed to the following factors:Teaching of professionalism at the University of Pretoria focuses on the humanistic attributes; which form an important part of patient consultations and teamwork.Medical students are not actively involved in the social contract that is prominent in the Charter. They have very little influence regarding social justice; access to care; distribution of resources and conflict of interest.The Charter is considered vague and open to interpretationIt is recommended that a universally acceptable charter be developed for the Medical School of Pretoria by involving faculty members to validate and accept the students' perspectives. It is also recommended that these mutually accepted attributes then be used as the assessment criteria of a professionalism assessment tool. This should also encourage faculty members to act as good role models

The impact of a new educational strategy on acquiring neonatology skills.

OVERVIEW: A shortage of staff for teaching neonatology skills to large numbers of students, in small groups and following a new curriculum, necessitated an innovative educational strategy. This entailed the development and implementation of an interactive multimedia program (CD-ROM) to deliver information about skills and to demonstrate them. METHODS: Students had to study a specific skill using the CD-ROM and then practise in the Skills Laboratory, supported by lecturers who provided formative evaluation. OBJECTIVES: The aims of this study were to assess the students' perspectives on the new strategy, and to compare the skills of students following the new curriculum to those of students following the traditional curriculum, who do not follow structured programmes on practical skills but experience a practical neonatology rotation. RESULTS: The evaluation of the CD-ROM program was very favourable. The majority of students still preferred live demonstrations but found the CD-ROM useful for revision purposes. With the exception of one skill, endotracheal intubation, the new curriculum students were found to be as competent as the students following the traditional curriculum and performed mask ventilation and cardiac massage significantly better than them.

Students' perceptions on skills training in simulation.

The University of Pretoria implemented a problem-oriented undergraduate medical curriculum that emphasizes experiential learning and the mastering of practical skills. Students' experiences with acquiring practical skills in a skills laboratory and the impact that acquiring these skills has on their clinical practice were explored and described. A qualitative, investigative, descriptive and contextual design was used. Data were collected at focus-group discussions and analysed using Tesch's methodology. A literature control was conducted to identify similarities of and uniqueness in the research findings. Trustworthiness was established by utilizing Guba's model for the trustworthiness of qualitative research (Lincoln & Guba, 1981). The findings were that attitudes, knowledge and skills are interrelated and contribute to an enhanced process of learning. The interrelated learning process has a positive effect when students progress from the skills laboratory to clinical practice. Students made valuable recommendations that should contribute to the optimal use of the skills laboratory.

[Financial advocacy: a true reality?]. / Finansiële voorspraak. Deaal of wevklikheid?

UNLABELLED: It seems that in spite of soaring medical costs and a poor economic climate, financial advocacy for patients is not general practice. A question that arises is what part nurses play and what their perceptions on financial advocacy for patients are. A non-experimental descriptive study was done to determine what nurses' perceptions on financial advocacy are and how knowledgeable they are about the costs of disposable dispensary stock. Thirty patient accounts were analysed and questionnaires were completed by a convenience sample of thirty two registered nurses who had permanent appointments in high care or intensive care units. RESULTS: On average nurses control the utilization of 15.8% of each of the prescription accounts. Only 12.5% of respondents had formal education on their responsibility in keeping costs low. The majority (60%) of the 50% of respondents who had previously received information had performed financial advocacy although 94% agreed that they have the responsibility to do so. A mere 9% was achieved on the knowledge of the costs involved in using consumable products from the dispensary.

[Professional secrecy]. / Professionele geheimhouding.

Confidentiality is a "sensitive" subject known to all professional nursing personnel. The perception of confidentiality in nursing students was determined during a research project. Some responses were surprising. The surprises were mostly due to the fast development in the medical and technology fields. These findings proved to be of significance in that guidelines for confidentiality are not up to date with the developments in these fields. These guidelines should be revised or rewritten to bring them up to date and help the professional nurse in decisions on aspects concerning confidentiality.

The development of a Weighted Objective Research Criterion Assessment Tool (WORCAT).

The aim of this study was to develop an instrument to evaluate research reports objectively according to set criteria, relative weights and critical errors. A tentative instrument was compiled and copies were sent to 144 university lecturers and senior lecturers at South African Nursing Science Departments in order to determine: the face validity of the assessment criteria of the 18 stated aspects of research reports, the weight or relative value of each of the aspects, how relationships between aspects should be evaluated. The relative value of each of the 18 aspects was determined by completing a matrix on which aspects were compared. The Analytic Hierarchical Procedure was used to determine the weight of each aspect. The WORCAT was developed from the findings and the most striking feature is the high relative weight allocated to each of the following aspects of research reports: recommendations = 20%; conclusions = 10%; literature study = 10%; problem statement = 7%. The reliability of the WORCAT still needs to be tested.

Disease-related needs of black patients with cervical cancer.

The high incidence of cervical cancer amongst South African black women is complicated by late presentation for treatment as well as by misconceptions and ignorance which adversely affect the quality of their lives. The aim of the research was to determine the disease-related needs of patients suffering from cervical cancer which would serve as a basis for planning on providing for these needs. Needs for the following were identified: Education on early detection in the community. Education on nutrition and hygiene. Information on and assistance in obtaining financial relief by means of subsidized transport and disability pensions.

Effects of blasts on the human body.

The compression and suction phases of blast dynamics manifest as shock waves and displacement waves respectively. The effects of a shock wave depends on the explosive charge, the distance from the explosion and the terrain and surroundings. Spalling, implosion, inertia and pressure differentials are mechanisms by which injury may be inflicted to the human body, especially to the gas containing organs. Displacement waves cause light objects to become high velocity missiles which may cause lacerations or penetrating wounds.