In this month’s Research Roundup, we look at some of the latest papers on professionalism including a handy app for students, quality indicators of postgraduate medical e-learning and….early predictors of exam performance for GP training! Read on!

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Professionalism is the holy grail and catch-all, it seems, but how do you Promote it? Model it? Or (heaven help us) remediate the lack of it?

These three papers address those aspects.

Self-reflected wellbeing using a smartphone app

This NZ study by Elizabeth Berryman et al describes a feasibility study into developing a phone app that medical students (and presumably postgraduate students also) could use to manage the depression, anxiety, burnout and suicidal ideation that many students experience that has been the subject of attention in the literature and in other media channels.

This was a mixed methods study involving a survey and focus groups to use self-reflected scores as a measure of wellbeing and how they changed before and after using the app.

Increased wellbeing was associated with:

Decreased wellbeing was associated with:

My own comment about this second list is that it is important to note that a number of these are issues where the student has identified they felt that way – possible explanations or causes for those feelings is not addressed.

Themes to emerge included: finding time for reflection, the utility of a tool that could help create habits of self-reflection and that daily reflection increased self-awareness of wellbeing.

Real food for thought and could it be used by practitioners as well?

Form your own view by reading about it here:

Illuminating exemplary professionalism

This study by Butani et al looks at appreciative inquiry as a strategy to stimulate learner reflection on exemplary professional behaviours.

Appreciative inquiry “explores and identifies successes and best practices within a culture so as to build on them (asset-based strategy for change) as opposed to focusing on the problems (deficit-based strategy).” So AI is a means for facilitating dialogue between learners and mentors.

Using a framework developed by others (Arnold and Stern) this paper uses the concept of professionalism as a virtue to which all physicians strive. The observable behaviours associated with it include clinical competence, ethical and legal understanding of the practice and the profession, and effective communication.

The four pillars that link all this are the aspirational values of humanism, altruism, accountability and excellence.

The themes that emerged from this study are:

Adopting a principle-based attitude such as thinking about patients not as their illnesses but as individuals was the most frequently identified intrinsic facilitator to professionalism.Emotional intelligence was also pretty important.

The authors also highlight the need for greater explicit discussion of self-humanism within the curriculum as a way to promote exemplary professionalism and foster resilience.

Framework for remediating unprofessional behavior and developing professionalism competencies and a professional identity

This paper by Barnhoorn et al highlights the concept of professional identity formation (PIF) – remember the term, you’ll be hearing a lot more about it in the future.

The adaptation of the multi-level framework by Korthagen that the authors espouse has the following levels and focus in medicine:

Environment – where am I?

Behavior – what am I doing?

Competencies – what can I do?

Beliefs and values – what do I believe in?

Identity – who am I?
Mission – why do I do what I do?

Depending on whether the perspective is behavior, attitude or process based, different strategies will apply.

Applying this to remediation means viewing professionalism through different viewpoints which will each have different goals.

For example, from the behavior based perspective, the goal of medicine is to deliver competent doctors to society who behave professionally. Behaviour is easy to measure and so can be potentially be remediated more demonstrably.

The goal of medical education from an attitude based perspective is to foster the virtues and values needed for good practice. But not so easy to measure or remediate (using reflection and feedback).

From the process-based perspective, the goal is the formation of the professional identity which is only achieved over time and in stages.

The use of the multi-level professional framework describes a nonhierarchical interplay between different levels relevant to professionalism.

This paper provides an illustration of how the multi-level framework can be applied.


Quality indicators of postgraduate medical e-learning

Perhaps surprisingly, this study by de Leeuw et al finds that there has never been a set of e-learning quality indicators!

So they set about developing such a list using 13 international education experts and 10 experienced users of e-learning in a Delphi study that can only have been a nightmare to administer!!! (but I digress).

They came up with a list of 37 indicators that grouped under the subjects of motivate, learn and apply.

Here’s a couple of examples of the indicators:

Motivate: provide an overview of all content, provide easy accessibility from all locations and devices.

Learn: allow non-linear learning, create interaction with the content.

Apply: make the content translatable to the real world, update and maintain the e-learning.

They think they’ve come up with the goods here! Judge for yourself:

Predictors of exam performance in GP training

This elegant paper by Rebecca Stewart et al looks at whether there were any associations between four predictor variables and the RACGP Fellowship exam components (AKT, KFP, OSCE or all three).

The predictor variables were: performance on selection assessment (includes a SJT and MMIs), MCQ, performance at ECTVs and supervisor assessment (as a dichotomous at or above expected standard vs behind expected standard).

The findings?

Firstly, the predictors of poor exam performance are different to those predicting the need for in-training remediation.

The pre-commencement MCQ, SJT and MMI are predictive of exam performance.

Selection scores and very early assessments can predict trainees more likely to be unsuccessful in the Fellowship exams.

“In-vivo” assessments of complex clinical performance predict the need for remediation.

So look for a big investment in an AKT-type assessment as part of selection!

Oh, and if you’re older and male your exam results may be not so hot.

Don’t take my word for it! There’s a lot more juicy detail in this one!

Go read the paper here:




Date reviewed: 31 October 2018

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