Teaching Professionalism in Postgraduate Medical Education: A Systematic Review

Abstract

Purpose This systematic review sought to summarize published professionalism curricula in postgraduate medical education (PGME) and identify best practices for teaching professionalism. Method Three databases (MEDLINE, Embase, ERIC) were searched for articles published from 1980 through September 7, 2017. English-language articles were included if they (1) described an educational intervention addressing professionalism, (2) included postgraduate medical trainees, and (3) evaluated professionalism outcomes. Results Of 3,383 articles identified, 50 were included in the review. The majority evaluated pre- and posttests for a single group (24, 48%). Three (6%) were randomized controlled trials. The most common teaching modality was small-group discussions (28, 56%); other methods included didactics, reflection, and simulations. Half (25, 50%) used multiple modalities. The professionalism topics most commonly addressed were professional values/behavior (42, 84%) and physician well-being (23, 46%). Most studies measured self-reported outcomes (attitude and behavior change) (27, 54%). Eight (16%) evaluated observed behavior and 3 (6%) evaluated patient outcomes. Of 35 studies that evaluated statistical significance, 20 (57%) reported statistically significant positive effects. Interventions targeting improvements in knowledge were most often effective (8/12, 67%). Curriculum duration was not associated with effectiveness. The 45 quantitative studies were of moderate quality (Medical Education Research Study Quality Instrument mean score = 10.3). Conclusions Many published curricula addressing professionalism in PGME are effective. Significant heterogeneity in curricular design and outcomes assessed made it difficult to synthesize results to identify best practices. Future work should build upon these curricula to improve the quality and validity of professionalism teaching tools.

Changing professional behaviours: mixed methods study utilising psychological theories to evaluate an educational programme for UK medical doctors

“…Despite a small second follow up sample, we found that some changes persisted three months after the intervention. Previous research also reveals that educational interventions in teaching professionalism can be successful [1,26,27]. Even though our study revealed that this educational intervention was successful in improving attitudes, subjective norms, perceived behaviour control and intentions, it is important to note that the effectiveness of the intervention depended on the complexity of the behaviour and participants' characteristics.…”

“…Teaching professionalism, however, is largely researched at undergraduate level and lacks the use of theoretical models (see systematic reviews [1,26]). A recent systematic review on teaching professionalism in postgraduate training concluded that formal, structured teaching can improve professionalism in medical trainees but it also found that the majority of studies were conducted within one institution and just one fifth of eligible studies included controlled groups [27]. The current study overcomes these limitations and adds to existing knowledge by presenting the findings from a high quality mixed methods study evaluating an educational intervention based on the theoretical model and using data from geographically spread multiple locations.…”

“…The study investigates the complex topic of teaching professionalism using a theoretical model and mixed methods design combining qualitative interview data and quasi-experimental design survey. Another strength of this study is that unlike the majority of studies in this area [27], data were collected from multiple geographically spread locations and participants from a variety of backgrounds, specialty areas, and levels of experience.…”

Teaching professionalism in medical residency programs: a scoping review protocol

“…EPAs, a relatively new concept in medical education [3], are addressed by accreditation graduate medical councils such as ACGME (Accreditation Council for Graduate Medical Education) [4]. They are addressed in competency frameworks such as CanMEDS (the Canadian competency framework introduced by The Royal College of Physicians and Surgeons of Canada [5,6] too.…”

“…As the authors of this review have concluded, finding best practices based on synthesizing previous findings, which were very heterogeneous, was difficult. It is also concluded that "even simple, short teaching sessions" would affect professionalism [6].…”