A qualitative thematic content analysis of medical students’ essays on professionalism

Abstract

BackgroundPhysicians in both Western and Eastern countries are being confronted by changes in health care delivery systems and medical professionalism values. The traditional concept of “In-Sul” (benevolent art) and the modern history of South Korea have led to cultural differences between South Korea and other countries in conceptualizing medical professionalism; thus, we studied medical students’ perceptions of professionalism as described in essays written on this topic.MethodsIn 2014, we asked 109 first-year medical students who were enrolled in a compulsory ethics course to anonymously write a description of an instance of medical professionalism that they had witnessed, as well as reflecting on their own professional context. We then processed 105 valid essays using thematic content analysis with computer-assisted qualitative data analysis software.ResultsThematic analysis of the students’ essays revealed two core aspects of professionalism in South Korea, one focused on respect for patients and the other on physicians’ accountability. The most common theme regarding physician–patient relationships was trust. By contrast, distributive justice was thought to be a non-essential aspect of professionalism.ConclusionsIn Western countries, physicians tend to promote justice in the health care system, including fair distribution of medical resources; however, we found that medical students in South Korea were more inclined to emphasize doctors’ relationships with patients. Medical educators should develop curricular interventions regarding medical professionalism to meet the legitimate needs of patients in their own culture. Because professionalism is a dynamic construct of culture, medical educators should reaffirm cultural context-specific definitions of professionalism for development of associated curricula.

O profissionalismo e suas formas de avaliação em estudantes de Medicina: uma revisão integrativa

“…The increment in the use of technologies and transformations in service provision forms have changed the relationship between doctor and patient, increasing the distance between them and enabling the emergence of unprofessional attitudes 1,11 .…”

“…Although there is not one single concept 1,2 , professionalism can be defined as a group of attitudes, values, behaviors and interactions that act as the basis of the health professional's contract with society 3 . It represents a complex, dynamic and multidimensional construct that is difficult to define and encompasses multiple and varied concepts which, many times, are dissimilar.…”

“…It represents a complex, dynamic and multidimensional construct that is difficult to define and encompasses multiple and varied concepts which, many times, are dissimilar. It also includes individual and behavioral factors that are learned throughout life and are influenced by sociocultural aspects 1,4 . Due to this, establishing an ideal model to teach and assess professional attitudes can be quite challenging 1,2 .…”

“…It also includes individual and behavioral factors that are learned throughout life and are influenced by sociocultural aspects 1,4 . Due to this, establishing an ideal model to teach and assess professional attitudes can be quite challenging 1,2 . Likewise, conducting such an assessment among medical students, capturing lapses or inadequate attitudes, is not an easy task 5 .…”

“…This art must be taught and improved in a broad, universal, ethical and humanistic way during the doctor's education 10 . Some changes undergone by Medicine throughout the years have caused the emergence of questionings about medical education and its forms of assessment and teaching inside universities 1,11 .…”