Developing personal attributes of professionalism during clinical rotations: views of final year bachelor of clinical medical practice students

Abstract

BackgroundMedical professionalism as a set of behaviours that transcends personal values, beliefs and attitudes to incorporate ethical and moral principles is considered a covenant between society and the practice of medicine. The Bachelor of Clinical Medical Practice (BCMP) a three year professional degree was launched at the University of the Witwatersrand in January 2009 in response to a documented shortage of doctors especially in the rural areas of South Africa. The BCMP programme is unique in its offering as it requires a teaching approach that meets the needs of an integrated curriculum, providing for an accelerated transition from the classroom to the patient’s bedside.MethodsFollowing five week attachments in designated District Education Campuses, 25 final year BCMP students were required to reflect individually on the covenant that exists between society and the practice of medicine based on their daily interactions with health care workers and patients for three of the five rotations in a one page document. A retrospective, descriptive case study employed qualitative methods to group emerging themes from 71 portfolios. Ethical clearance was obtained from the Human Research Ethics Committee at the University of the Witwatersrand.ResultsAs an outcome of an ethical analysis, the majority of BCMP students reflected on the determinants of accountable and responsible practice (N=54). The commitment to the Oath became significant with a personalised reference to patients ‘as my patients’. Students acknowledged professional health care workers (HCWs) who demonstrated commitment to core values of good practice as they recognised the value of constantly reflecting as a skill (n=51). As the students reflected on feeling like ‘guinea pigs’ (n=25) migrating through periods of uncertainity to become ‘teachable learners’, they made ethical judgements that demonstrated the development of their moral integrity. A few students felt vulnerable in instances where they were pressured into ‘pushing the line’.ConclusionsThrough their portfolio narratives, BCMP students showed a willingness to shape their evolving journeys of moral growth and personal development. This study has highlighted as an ongoing challenge the need to identify a process by which professionalism is sustained by HCWs to benefit health sciences students.

Reflecting on BCMP students’ experiences of professionalism during clinical rotations

“…Hatem's [9] definition of professionalism (Box 1) adopted as a working definition for the BCMP programme was the stimulus that Reflecting on BCMP students' experiences of professionalism during clinical rotations Nontsikelelo Mapukata-Sondzaba, 1 MSc, BTech; Ames Dhai, 2 MB ChB, FCOG (SA), LLM guided the 25 final year BCMP students' reflections. The students' experiences of the contextual attributes of professionalism during clinical rotations were received as portfolio entries.…”

“…For a detailed description on the research design -a retrospective, descriptive, analytical case -based study as well as data collection me thods, the reader is directed to the published article. [1] Ethical clearance was obtained from the Human Research Ethics Committee (HRECMedical: M110740) of the Faculty of Health Sciences at Wits. BCMP students' responses informed by Hatem's definition, were openended and not grouped into categories.…”

“…[1] Nonetheless rich data sets, obtained using acceptable scientific methods, had to be compressed to answer critical questions for this programme.…”

“…[8] This was true for the BCMP programme which accepted its first cohort of students at the University of the Witwatersrand (Wits) in January 2009. [1] With a unique and integrated curriculum, the students are based in District Education Campuses in urban and/or underserved facilities in Gauteng or in rural facilities in the North West Province. On completion of their studies, these healthcare practitioners are known as Clinical Associates and are based in district hospitals where they work under the supervision of a family physician.…”

“…On completion of their studies, these healthcare practitioners are known as Clinical Associates and are based in district hospitals where they work under the supervision of a family physician. [1] Contextual attributes of professionalism -also referred to as core elements by the HPCSA -are attributes or domains that constitute a spectrum of behaviours that should be exhibited by all categories of healthcare practitioners (HCPs) at the end of the training period. [10] They are the desired qualities in any doctor-patient relationship that need to be displayed in the contexts in which they practise and are associated with the physician as a healer in society.…”