WEDNESDAY 29TH AUGUST 2018

10I: Short Communications: 10I2 (378) Talking about professionalism, do we have the words? A Professionalism qualitative study to explore internal residents’ Location: Rio, 2nd Floor, CCB and attending ' understanding of Date: Wednesday 29th August professionalism Time: 0830-1015 hrs Authors 10I1 (317) Marco Mancinetti, University and Hospital of Fribourg, What Can We Learn from the Analysis of Top-cited Switzerland Articles in Medical Professionalism? Janko Kaeser, IML, University of Bern, Switzerland Christoph Berendonk, IML, University of Bern, Switzerland Authors Samy Azer, King Saud University, Riyadh, Saudi Arabia Presenter: Marco Mancinetti, University and hospital of Fribourg, Switzerland Presenter: Samy Azer, King Saud University, College of Medicine, Riyadh, Saudi Arabia Background: Little attention has been given to the perspectives of practicing physicians on professionalism. Background: Physicians are expected to demonstrate We don’t know what residents and attending in professional behavior in their day-to-day practice. Citation internal medicine understand about professionalism and if counts of articles have been used by universities and they can speak about it. The aim of this study is to explore funding bodies to measure scientific outcomes and assess their discourses about it. suitability for grant applications. With the rise of social Our research questions: how residents and attending media, altmetric scores could provide an alternative physician define professionalism, what they recognize as assessment tool. Considering these two measures, it was unprofessional and how they teach it and learn it. decided to assess the highly cited articles on medical Method: The methodological framework was based on the professionalism. principles of the discourse analysis. 7 Focus groups were Method: The Web of Science was searched for most cited conducted with a total of 35 residents and attending articles on medical professionalism. The identified articles physicians from the department of internal medicine of 4 were searched for key characteristics. The altmetric different tertiary hospitals in Switzerland. All three database was searched to identify report for each article. investigators independently reviewed transcripts and A model to assess the relationship between the number of developed codes in an iterative process. citations and each of key characteristics as well as Results: Participants in our focus groups couldn’t speak altmetric scores were developed. easily about the definition of professionalism, stating that Results: No correlations were found between the number the meaning of professionalism is blurred for them. of citations and number of years since publication When speaking about the flaws of professionalism the (p=0.192), number of institutes (p=0.081), number of grey zones were difficult to determinate and lead to an authors (p=0.270), females in authorship (p=0.15), or unresolved agreement. Learning, teaching and assessing number of grants (p=0.384). The altmetric scores varied professionalism was an issue for the participants of the from zero to 155, total= 806, median=5.0, (IQR=20). interviews. Twitter (54%) and Mendeley (62%) were the most popular Analysing the discourses using the frameworks described altmetric resources. No correlation was found between by Irby we found that the participants were expressing the number of citations and the altmetric scores (p=0.661). definitions proper to either a virtue-based professionalism, Discussion & Conclusions: The top topics covered were behavior-based professionalism or professional identity learning and teaching professionalism, curriculum issues, formation. Many aspects of unprofessional behavior were professional and unprofessional behavior, defining and referring to the discourse of complexity as reported by measuring professionalism. Only the number of countries Monroux. During the conversation about teaching and correlated with the number of citations (p= 0.001). learning we observe that professionalism is forged more Countries that contributed to these articles were mainly by an empirical approach (observation and imitation) the USA, Canada, and the UK and the articles were mainly rather than by lectures and handbooks. published in Academic Medicine, Journal of the American Discussion & Conclusion: Our findings suggest that if Medical Association, Journal of General Internal Medicine, practicing physicians don’t have the basis to speak about and Annals of Internal Medicine. Future studies should professionalism they will then struggle to recognize what investigate the specific features of highly cited articles that is unprofessional. This leads to an improvised approach to contributed significantly as a resource in medical curricula, educational strategies which results in un-systematic ways research or postgraduate training. of learning, teaching and assessing professionalism. Take-home message: Top-cited articles in professionalism We must give the right words to the medical professionals offer a useful resource to students and teachers interested to speak about professionalism, this would give them a in this area. consciousness of their professional values, helping them learn, teach and assess professionalism in their everyday work.

AMEE 2018 ABSTRACT BOOK 1

WEDNESDAY 29TH AUGUST 2018

10I3 (253) medical students engage with their superiors and patients, Sri Lankan and Taiwanese Students' Professionalism whether they voice concerns or seek assistance and Dilemmas: Understanding Gender and Power Imbalances affects their emotional status. Future research might through Narratives consider how such experiences impact on students’ development as future doctors and on burnout. Authors Malissa Shaw, Chang Gung Memorial Hospital, Linkou, 10I4 (1811) The struggle for professionalization – students´ Madawa Chandratilake, University of Kelaniya, Colombo, Sri experiences of emotionally challenging situations during Lanka medical school Ming-Jung Ho, Weill Cornell Medical College, Qatar Charlotte Rees, Monash University, Clayton, Australia Authors Lynn Monrouxe, Chang Gung Memorial Hospital, Linkou, Annalena Lönn Taiwan Maria Weurlander Robert Thornberg Presenter: Lynn Monrouxe, Chang Gung Memorial Astrid Seeberger Hospital, Linkou, Taiwan Håkan Hult Annika Wernerson Background: Social constructs such as status, gender inequality and religious stratification are reproduced in Presenter: Annalena Lönn, CLINTEC, Karolinska Institutet, medical settings. Such values impact medical Stockholm, professionals’ behaviours, ethical reasoning and sense of empathy: essentially their medical professionalism. As Background: The professionalization process is an notions of medical professionalism are context-specific, important part of . During clinical this study considered Sri Lankan and Taiwanese medical placements, students encounter situations that can be students’ experiences of professionalism dilemmas: emotionally challenging, such as witnessing situations in which they witnessed or participated in patents´suffering, death and a detached health culture. unprofessional practice. The aim of the study, was to investigate how medical Method: As part of a larger international research students manage situations they perceive as being programme, this qualitative study comprised 26 focus emotionally challenging and what they learn during the groups (n=136 participants) at a Sri Lankan (n=71) and process. Taiwanese (n=64) medical school. Participants described Method: Qualitative data was collected from 86 students professionalism dilemmas they had experienced during during their last semester. The students were asked to their clinical education. Audio-recorded data were describe, in writing, situations they perceived as being anonymised, transcribed and thematically analysed to emotionally challenging and also to describe if and how identify students’ professionalism dilemmas. their ability to Results: Students narrated diverse professionalism manage these situations had changed during medical dilemmas including patient safety and dignitiy breaches, school. A constructivist grounded theory approach was alternative medicine and family inteventions. Here, we used to analyze the data. focus on patient, healthcare professional (HCP) or student Results: Medical students´ main concern in situations they mistreatment. Narratives from Taiwan were embedded in perceive as being emotionally challenging, is the struggle notions of power imbalances. Those from Sri Lanka also to achieve a professional approach. This includes being included gender inequality. Mistreatment towards able to focus on the task in a demanding situation and to students and other HCPs was generally psychological. maintain the ability to show empathy. Active reflection Mistreatment of patients also occasionally compromised and debriefing with peers and close relatives are patients’ health. For example, prescribing pregnant important when reolving the main concern.Other women oxytocin to induce labour to adhere to doctors’ strategies are to actively expose themselves to stressful schedules. Some narratives emphasized patients’ situations and the search for good role models.In this mistreatment of students and HCPs, such as patients being process, students get insights about how they can relate rude to nurses but respectful toward doctors. to patients and medical staff, and learn about what their Discussion & Conclusion: Sri Lankan and Taiwanese own needs are in order to cope. students’ narratives of professionalism dilemmas Discussion & Conclusion: Medical students´experiences of demonstrate how social constructs are reproduced in emotionally challenging situations, evoke feelings that healthcare. In these societies women typically hold they have to manage in order to become a professional. subordinate social positions, contrasting with the high Students take an active part in this process – being aware social status of doctors. In Taiwan, low numbers of female of the importance of resolving the negative feelings that medical professionals and students reflect this. The emerge. The learning outcome in this process seems to be hierarchical nature of Sri Lankan and Taiwanese medical the insight about one´s own reactions, shortcomings and cultures further subordinate female students and other needs. HCPs, such as nurses, exposing them to increased Take-home message: To experience and learn how to mistreatment and impacting the quality of patient care. manage emotionally challenging situations is an important Take-home message: Experiencing gender- and power part in the struggle of becoming a professional physician. imbalance-related professionalism dilemmas impacts how Increased knowledge about this process may help faculty

AMEE 2018 ABSTRACT BOOK 2

WEDNESDAY 29TH AUGUST 2018 and supervisors to better support students in this. Authors challenge. Jamileh Ramazani, School of and Midwifery, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran 10I5 (648) Mohammad Hosseini, School of Nursing and Midwifery, Remediation of unprofessional behaviour in the UK: the Mashhad University of Medical Sciences, Mashhad, Iran ‘unknown unknown’ Abbas Heidary Hossein Karimi Moonaghi, Iran Authors Susannah Brockbank, University of Liverpool, Liverpool, UK Presenter: Jamileh Ramazani, School of Nursing and Viktoria Joynes, University of Liverpool, Liverpool, UK Midwifery, Bojnourd Branch, Islamic Azad University, Vikram Jha, Apollo Hospitals Group, Chennai, India Bojnourd, Iran

Presenter: Susannah Brockbank, University of Liverpool, Background: Nursing as a key profession comprises many UK values inherent in those who pursue nursing careers, and like any profession, nursing needs to develop its identity. Background: A link between unprofessional behaviour as To create the credibility and a positive image of nursing, a medical student and later misconduct post-qualification we should repeatedly define this dynamic concept. has been well described. This correlation has led to calls Method: Following a literature review, an extensive for robust remediation of lapses in professionalism at investigation was carried out using English and Persian medical school, including a mandate from the UK medical studies in Scopus, PubMed, Web of Science, Cochrane, and regulator, the General Medical Council, to address this ProQuest, using the following keywords: “nursing”, behaviour. Unfortunately, there is a dearth of evidence for “professionalism”, “nursing professionalism”, and how remediation can be successfully achieved. “professionalism in nursing”. Finally, 14 articles published Furthermore, a North American study revealed that from 2010 to 2018 were selected for the final analysis. remediation practices vary across medical schools, so this After extracting data from the selected articles, the data study aimed to explore the remediation practices in UK summarized and classified. (UK) medical schools. Results: Although there is no consensus about the Method: An online survey was sent to all UK medical definition of nursing professionalism, but based on the schools in early 2017. This survey contained a combination extracted data from selected articles, we chose most of multiple choice questions and free text answers. identified indicators for definition of professionalism in Information about the medical school’s demographics, as nursing, including: communication, self-awareness, self- well as current methods of identification and remediation care, professional image, responsible learning (pursuit of of professionalism lapses, was requested. Responses were new knowledge), personal accountability, personal subject to inductive qualitative analysis. integrity, honesty, intellectual and individual responsibility, Results: 13/36 (36%) of UK medical schools responded to belief and respect in human dignity, equality of all the questionnaire. These responses revealed a variation in patients, desire to prevent and alleviate suffering. practice in terms of identification of lapses, with a minority Discussion & Conclusion: Nursing professionalism, not schools having formal systems in place. Participants also only involves standards and policies but also includes expressed uncertainty regarding how best to undertake other important aspects like personal beliefs and values. remediation and, as well as how to ensure its success. There are numerous contextual variables that affect Discussion & Conclusion: The response rate to this survey individuals' perceptions of professionalism, for example demonstrates a lack of engagement of UK medical schools hidden curriculum provides conditions for leading nursing with the debate about remediation of unprofessional students to professionalism. The educational environment, behaviour, possibly symptomatic of the uncertainty practicing nurses, expert faculty, and a speaker can expressed by our respondents. Furthermore, this produce a sense of excitement about their chosen career uncertainty reflects the paucity of evidence, policy and in nursing students. procedure for remediation of unprofessionalism. This in Take-home message: Instructors should create an ideal turn stems from a lack of understanding of the educational atmosphere to familiarize the students with determinants of unprofessional behaviour in medical the core attributes of nursing professionalism by helping students, which acts as a barrier to remediation. them to understand the opportunities, responsibilities, Take-home message: Establishing evidence-based and concerns that are integral to the nursing profession. strategies for remediation of unprofessional behaviour should be a priority for medical schools. In order to remediate lapses in professionalism successfully, determinants of unprofessional behaviour must first be better understood. A framework for remediation can then be created in light of this understanding, from which a broader evidence base for remediation strategies can develop.

10I6 (3610) Nursing Professionalism: a dynamic concept

AMEE 2018 ABSTRACT BOOK 3

WEDNESDAY 29TH AUGUST 2018

10I7 (756) Professionalism and reflection: a multidisciplinary experience

Authors Maria Paz Grebe, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina Malena Sayal, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina Silvina Creus, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina Maria Laura Miglietta, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina Soledad Campos, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina Angel Centeno, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina

Presenter: Angel Centeno, Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina

Background: Evidence shows that reflection helps to develop thinking abilities and enhance professionalism among students of health sciences. Choosing a significant critical situation, registering it, and actively thinking about it and discussing the information with a tutor have been described as evidences of reflection. The aim of this study was to assess the student’s reflection skill about professionalism in three careers (medicine, nursing and psychology) at the beginning of their clinical practice. Method: Medicine, nursing and psychology students were invited to describe a significant situation that impacted them in a remarkable way. Then they were asked to write a reflection about this situation, and were later interviewed by a faculty member. The Reflective Ability Rubric and User Guide (O’Sullivan) was applied to both moments the written reflection and the interview. Results: Students were able to identify professionalism attributes in the clinical practice and learn from the significant situation. Psychology students refered more frequently to situations that they lived as a passive observers. Conversely, medical and nursing students reflected about situations that they lived as active actors. Nursing students reflections evidenced that patient care situations impacted them in an affective way. Reflection levels differed among disciplines, being more superficial in Psychology, but when students were interviewed by a faculty member they achieved a deeper reflection level. Discussion & Conclusion: This study shows that the experiences lived by the students in the practical field induce their reflection skill, that there are differences in the three disciplines and that the interaction with a faculty member, promotes a deeper reflection and the ability to understand the situation. Take-home message: Reflection should be incorporated in the curriculum as a systematic activity. Primarily when students are in the clinical practice facing situations related to professionalism.

AMEE 2018 ABSTRACT BOOK 4