The public judge misdemeanours among medical students more harshly than do medical students and medical professionals. This implies that views of lay members should be sought by medical schools when promoting professionalism and considering cases of medical student misconduct.

Background:The concept of professionalism is dominant within health care education and the lives of practising clinicians globally, and yet there is no single agreed definition nor framework applied universally across the health care professions. This article questions how much attention is paid to where definitions of the concept of professionalism came from and whether the accepted norms within the dominant discourses are still truly applicable to a 21st century workforce.Method: Taking a critical look at the existing body of literature on professionalism using a locus of medical education, this article reviews who the dominant voices have been in the creation of current understandings of professionalism. Using a pragmatic and targeted approach, regulatory body definitions of professionalism from across the world are compared to demonstrate the complexities of finding a universally accepted definition of the concept. Results:The article suggests that the extant definitions are grounded but also stuck in a background of Western, White, heteronormative view of society and the professions of the past and argues that we need to better understand the expectations of professionalism from the perspectives of those who now work in health care and health care education, as well as reviewing the views of the "public" within this debate.Conclusions: By reopening the "Pandora's box" of professionalism, this article argues that we can improve the quality of definitions-and thus application-of professionalism for health care professionals and patients.

Fitness to practice decisions are often based on a student's digression from the regulations, with limited exploration of the reasoning behind the student's behavior. However, behavior is underpinned by complex, "hidden" variables, including an individual's attitudes and social norms. Examining hidden determinants of professionalism, such as context, interpersonal relationships, social norms, and local cultures, then allows medical educators to develop a richer understanding of unprofessional behavior.In this article, the authors propose the use of the theory of planned behavior (TPB) as a framework to help evaluate unprofessional behavior in students. The TPB is a deliberative processing model that explains how an individual's behavior is underpinned by his or her cognitions, with behavior being primarily dependent on the intention to perform the behavior (behavioral intention). Intention, in turn, is determined by three variables: attitude, subjective norm, and perceived behavioral control.To understand the practical use of the TPB, the authors present four complex, anonymized case studies in which they employed the TPB to help deal with serious professionalism lapses among medical students. The outcomes of these cases as well as the student and program director perspectives, all explained via the TPB variables, are presented. The strengths and limitations of the TBP are discussed. 4Internationally, regulatory bodies dictate that graduating medical students' outcomes move beyond acquisition of knowledge and skills to include appropriate professional attitudes and behaviors, 1-5 requiring students not just to behave professionally but also to become professional. [6][7][8] The importance of recognizing lapses in professionalism early is borne out by studies showing unprofessional behavior by medical students predicts subsequent misconduct. 9-13 Consequently, teaching and assessing professionalism is gaining momentum globally, 14-17 with approaches varying among nations from consensus statements (e.g., UnitedStates and Canada) 5,18 to medical student licensure (e.g., Australia When a student's fitness to practice (FTP) is called into question, educators undertake a complex decision-making process: collecting evidence, evaluating the nature and severity of the misconduct, and deciding whether to refer the student to an FTP panel. FTP panels make decisions based on the evidence, with students who are in breach of professional behavior being subject to sanctions ranging from formal warnings to expulsion from the program.Often these decisions are based on the student's digression from the regulations, with limited exploration of the reasoning behind the student's behavior. [30][31][32] However, behavior is underpinned by complex, "hidden" variables, including an individual's attitudes and social norms. 33 Examining hidden determinants of professionalism, such as context, 34,35 interpersonal relationships, social norms, and local cultures, 36-38 then allows us to develop a richer understanding of unprofession...

No abstract