A Pilot Study on Professionalism of Future Medical Professionals in Universiti Kebangsaan Malaysia (UKM) Medical Centre

Abstract

Professionalism a is multidimensional concept but there are core professionalism issues which are unique for all professions. A pilot study was conducted in 2011among 50-UKM-medical students chosen randomly from year 1-5 to investigate their professionalism. Data was collected using a developed instrument concerning 40 items, assessed using 5-point Likert scale under nine core issues. Total mean professionalism score for all nine issues in year-1 students was 178/220 and in the subsequent years were 169/220, 173/220, 171/220 and 175/220. Internal consistency of the instrument was adequate. Educators especially the faculty should emphasize on core professionalism issues to promote professionalism in future professionals.

Full text

Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
1877-0428 © 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and Learning Congress 2011
doi: 10.1016/j.sbspro.2012.09.419
UKM Teaching and Learning Congress 2011
A pilot study on professionalism of future medical professionals in
Universiti Kebangsaan Malaysia (UKM) Medical Centre
Abdus Salam
a
*, Chew Ooi Song
b
, Nur Farhana Mazlan
b
, Hayati Hassin
b
Lim Soon Lee
b
, Muhammad Hazwan Abdullah
b
a
Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia
b
Fifth Year Medical Students, Universiti Kebangsaan Malaysia
Abstract
Professionalism is a multidimensional concept but there are core professionalism issues which are unique for all professions. A
pilot study was conducted in 2011among 50-UKM-medical students chosen randomly from year 1-5 to investigate their
professionalism. Data was collected using a developed instrument concerning 40 items, assessed using 5-point Likert scale under
nine core issues. Total mean professionalism score for all nine issues in year-1 students was 178/220 and in the subsequent years
were 169/220, 173/220, 171/220 and 175/220. Internal consistency of the instrument was adequate. Educators especially the
faculty should emphasize on core professionalism issues to promote professionalism in future professionals.
© 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and Learning
Congress 2011.
Keywords: Academic medical centre; future medical professionals; pilot study; professionalism
1. Introduction
Professionalism is an umbrella concept used to describe many different aspects of a profession (Wilensky 1964).
A profession is an occupation that requires prolong training and formal qualification (Cruess et al., 2004; Freidson,
2001). ‘Professions’ are groups, which announce in a public way that their members will act in certain ways, and
that the group and society may discipline those who fail to do so; people who choose the profession had history of
doing ‘good’ or one can say ‘good’ people had chosen the profession (Faiz, 2003). Moloney (1986) describes
professionalism as commitment to ones’ work and the orientation towards service rather than personal profit.
Members of a profession are governed by codes of ethics to the promotion of public good within their domain
(Cruess et al., 2004). Customer service, work ethics and business integrity are often grouped together with
professionalism.
* Corresponding author. Tel.: +6-03-9145-7973; fax: +6-03-9145-6678
E-mail address: salam@ppukm.ukm.edu.my
Available online at www.sciencedirect.com
© 2011 Published by Elsevier Ltd. Selection and/or peer reviewed under responsibility of the UKM Teaching and
Learning Congress 2011

535
Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
Many people think they are professionals and used the word ‘professionalism’ differently for different reasons
(Swick, 2000). Professional proficiency is of utmost importance to accomplish the practice of a profession
efficiently (Salam et al., 2008c; Villegas-Alvarez et al., 2007). Professional proficiency comprises a set of core
values or fundamental elements in addition to mastery of broad scientific knowledge and skills of a profession and
these are the aspects of humanism. Professionalism although is an umbrella or multidimensional concept, its core
values or humanistic aspects such as respect, accountability, responsibility, caring, leadership, altruism, compassion
etc. (Maryland, 2002) are unique and equally applicable to all professions.
Medicine is a profession that requires high standards of behavior in terms of core values of professionalism, such
as who can communicate effectively with patients, patients’ families and colleagues; act in a professional manner,
be aware of socio-cultural diversities, values, prejudices, and provide care with understanding of those values and
various dimensions of patient’s lives (Salam & Rabeya, 2009; Litzelman & Cottingham, 2007). The corporate
transformations of health care system erode the professionalism of physician (Sullivan, 1999; Swick et al., 1999).
Poor communication aspects of physicians (Salam et al., 2008a) and lack in practice of core issues of
professionalism .make general public and patients even colleagues, more dissatisfied than deficiency in any other
clinical competencies in the medical profession. Medical educators are already concerned about the erosion of
medical professionalism because of the attitudes and behaviors of practicing physicians, particularly by the faculty
(Swick et al., 1999). Students who are the customers of medical educational industry are seldom aware of the core
issues or humanistic aspect of professionalism (Project professionalism, 1995). Medical students often receive
contradictory messages between what they hear in the class room and what they see in the real setting about core
values to demonstrate (Inui, 2003; Hafferty & Franks, 1994; Reynolds, 1994). If faculties are responsible for
teaching professionalism but fail to demonstrate its core issues before their students by not doing so, then clearly
professionalism is missing in the students’ education; so the contemporary medical student tends to become less
idealistic by his or her fourth medical year (Christian, 2008; Hilton & Slotnick, 2005) even though they read by
themselves and hear formally about core issues of professionalism. Students tend to do so as their teachers do
(Christian, 2008; Feudtner, 1994; Hafferty & Franks, 1994). As such, there is growing consensus among medical
educators to promote professionalism in medical students (Litzelman & Cottingham, 2007) especially to expand the
core humanistic aspects. The purpose of this pilot study was to test the feasibility of research in order to identify the
conceptual understanding of professionalism with emphasis on its core issues among medical students in the UKM
Medical Centre aimed at professional development of future medical professionals.
2. Methodology
This was a cross sectional study on core values of professionalism, piloted in early 2011 among medical students
of UKM Medical Centre. A sample of 50 students comprising of 10 students from each year of 1-5 of academic
session 2010-2011 was chosen randomly, using stratified sampling technique. An instrument on professionalism
was developed through extensive review of literature, which contained nine core professionalism attributes such as
honesty, accountability, confidentiality, respectfulness, responsibility, compassion, communication, maturity and
self-directed learning. There were a range of statements under each professionalism issues which was assessed using
a 5-point Likert scale. Mean of all nine attributes’ scores represented the professionalism of respondents as a whole.
The instruments also contained four open ended questions researching about respondents’ opinion on what
professionalism meant to them, how professionalism should be taught, how they learnt professionalism and how
professionalism should be assessed. The data was then compiled and analysed using SPSS version 17.
3. Results
Out of 50 respondents, 40% were male and 60% were female (Fig-1). Scores of different elements of
professionalism between male and female respondents are shown in Table-1, which are almost similar. Scores of
different elements of professionalism among the respondents of different study-years are shown in Table-2, which
are also almost similar. Of a maximum total professionalism score of 220, mean score of first year students was 178
and subsequent years were 169, 173, 171 and 175 respectively (Fig-2).
Research on what professionalism is meant to the respondents, how it should be taught, how they learnt and how
professionalism should be assessed are shown in Table 3. This table revealed that professionalism means positive

536 Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
attitude and behaviour towards job as expressed by 46% respondents while 8% respondents were unaware of
professionalism and the rest defined it in other ways. Thirty four percent of the respondents stated that
professionalism should be taught through experience and more than that (38%) felt that they learnt professionalism
through experience. Half of the respondents reported that professionalism should be assessed formally.
40%
60%
Male
Female
Figure 1. Gender distribution of the respondents
Table 1. Gender-wise scores of elements of professionalism as well as mean scores of all elements, n=50
Element of
professionalism
Maximum
scores
Gender-wise scores of core elements of
professionalism
Male (n=20)
Female (n=30)
Honesty
30
23.75
21.17
Accountability
25
18.70
18.87
Confidentiality
20
15.85
16.37
Respectful
30
24.65
24.10
Responsibility
30
23.45
24.00
Compassion
20
16.50
16.93
Communication
25
19.70
19.43
Maturity
30
22.55
23.63
Self-directed learning
10
8.35
8.33
Mean scores of all
elements
220
173.50
172.83

537
Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
Table 2. Year-wise scores of core elements of professionalism as well as mean scores of all elements, n=50
Elements of
Professionalism
Maximum
scores
Year-wise scores of core elements of professionalism
First year
(n=10)
Second year
(n=10)
Third year
(n=10)
Fourth year
(n=10)
Fifth year
(n=10)
Honesty
30
23.84
23.38
20.42
22.83
21.84
Accountability
25
20.21
18.16
18.21
18.59
18.75
Confidentiality
20
16.91
15.75
17.54
15.21
15.12
Respectful
30
24.59
23.21
24.33
24.67
25.09
Responsibility
30
24.50
23.04
24.21
22.54
24.34
Compassion
20
17.71
15.96
16.84
16.25
16.84
Communication
25
20.42
18.17
19.83
19.16
20.25
Maturity
30
21.66
23.00
23.42
23.21
24.17
Self-directed learning
10
8.58
8.04
7.91
8.50
8.67
Mean score of all
elements
220
178.42
168.71
172.71
170.96
175.07
164
166
168
170
172
174
176
178
180
1st year
2nd Year
3rd Year
4th Year
5th year
Figure 2. Mean professionalism scores among the respondents of different study-years (maximum score 220)

538 Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
Table 3. Respondents’ opinion through open ended questions on researching what professionalism is meant to them, how it should be taught, how
they learnt professionalism and how it should be assessed.
What do you mean by
professionalism?
How professionalism should
be taught?
How do you learn
professionalism?
How professionalism
should be assessed?
Opinion
n
%
Opinion
n
%
Opinion
n
%
Opinion
n
%
Positive
attitude and
behaviour
towards job
23
46
Experience
17
34
Experience
19
38
Formally
25
50
Others
20
40
Formal
education
16
32
Role
model
12
24
Others
10
20
Unsure
4
8
Role model
8
16
Others
9
18
Feedback
and self-
reflection
7
14
Skilful
3
6
Others
5
10
Formal
education
7
14
Unsure
7
14
Unsure
4
8
Unsure
3
6
Can not
1
2
Total
50
100
Total
50
100
Total
50
100
Total
50
100
4. Discussion
Medicine is a profession that forms the basis of contract between doctors and society (Hilton, 2005; Irvine,
2003). The professional role of physicians involves a commitment to uphold social order by providing good moral
judgment, and ethical practices of medicine (Bryan et al., 2005; Patenaud et al., 2003; ABIM, 2002; Fadar et al.,
1989). The aim of physician is to cure sometimes, relieve often and comfort always (Salam et al., 2008a; Lloyd and
Bor, 1996). To comfort always, medical professionals requires a high standard of behavior that ensures use of core
issues of professionalism in addition to the mastery of a large body of knowledge and clinical skills (Litzelman &
Cottingham, 2007).
This study was about a group of UKM medical students where the number of female students is more than male
students (Fig-1). In terms of scores of core elements of professionalism such as honesty, accountability,
confidentiality, respectful, responsibility, compassion, communication, maturity and self-directed learning between
male and female respondents with varying educational background were found to be almost similar with slightly
high score (173.50) obtained by male respondents than female (Table-1). Nath et al., (2006) expressed that the core
values of professionalism may vary widely with gender, study-year and socio-cultural background. Professionalism
score in its core issues among the respondents of different study-years also were found closely similar (Table-2).
Environment plays a vital role in influencing the development of professionalism (Cruess et al., 2008). The closely
similar scores in core issues of professionalism between different gender and study-years of the respondents in this
study may reflect that a non-threatening collaborative educational environment is maintained in the institution. To
promote any educational development, intradepartmental and interdepartmental support and collaboration is very
much important rather than any competitive efforts. Brown et al., (2009) and Duke et al., (2005) reported that
students’ attitudes toward professionalism tend to deteriorate during their years of training. This study revealed that
out of a total score of 220, first year students scored 178 and the subsequent years scored 169, 173, 171, 175 and 173
respectively (Fig-2), which is consistent with the reports made by Brown et al., and Duke et al.
Answering to an open ended question, what professionalism is meant to them, 46% respondents stated that
professionalism means positive attitudes and behaviour towards job, 8% were unaware of its meaning and the rest
defined professionalism in different ways (Table-3). This finding has similarities with the statement made by Swick
(2000) where it is mentioned that professionalism is easy to recognize but difficult to define as different people use
the word differently for different reasons. Here is the educators’ role to put emphasis on clear understanding and
practice on core issues or humanistic aspect of professionalism. Professional development is difficult if the academy
lacks consensus on clear understanding of the core issues of professionalism (Brown et al., 2009).

539
Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
Professionalism may be inherent to socio-cultural background and past experience (Nath et al., 2006), but
lecturers play important role in the development of student’ skills during their undergraduate course (Salam et al.,
2011c; Nabishah et al., 2009). Many studies reported that, the personality of a lecturer has a strong effect on the
development of professionalism to their students (Haghdoost & Shakibi, 2006; Gillespie, 2002; Pelaez & Gonzalez,
2002; Kiker, 1973). Thirty four percent respondents in the present study opined that professionalism should be
taught through experience while 38% and 24% respondents felt that they learnt professionalism through experience
and role model respectively (Table-3). Various studies reported that professionalism is best learned from faculty role
models (Salam et al., 2010b; Brown et al., 2009; Cruess et al., 2008; Goldie et al., 2007; Cote & Leclere, 2000;
Reynolds, 1994). Findings of the present study regarding learning professionalism through role models have
similarities with various other study reports. Role models are those who teach by example (Kenny et al., 2003;
Robert, 2001) and it is the educational process through which students learn the skills of observation,
communication and professionalism (Salam et al., 2011b).
Teaching professionalism through formal education is now very much accepted (Hilton, 2005; Irvine, 2003). But
this study found that students ranked the formal education at second position when they were asked “how
professionalism should be taught,” and ranked formal education at fourth position when asked “how do you learn
professionalism”; half of the respondents felt that professionalism should be assessed formally. Students emphasized
on experience and role model in regards to learning of their professionalism (Table-3), which indicates that role
model has great role in teaching professionalism through formal education. Excellent role models always inspire and
ensure simplicity and specificity of an educational programme in order to have a common understanding of the core
concepts and to achieve crystal-clear learning outcomes (Brown et al., 2009).
5. Conclusion
This pilot study found that majority of the UKM medical students has common conceptual understanding on core
issues or humanistic aspects of professionalism with insignificant differences between gender and study-years.
Priority has been given to experience and role modeling in order to promote professional development of future
medical professionals. The internal consistency of this research instrument was adequate. It is concluded that
research on core issues or humanistic aspects of professionalism among UKM medical students is feasible.
Educators need to emphasize on the practice of core issues of professionalism, especially by faculty to develop
professionalism to their medical students, ultimate aim of which is to ensure delivery of quality health care system
for the welfare of society.
Acknowledgement
We would like to thank Universiti Kebangsaan Malaysia for providing the research grant FF-020-2011.
References
ABIM-American Board of Internal Medicine Foundation, ACP-ASIM Foundation-American College of Physician-American Society of Internal
Medicine, European Federation of Internal Medicine. (2002). ‘Medical professionalism in the new millennium: a physician charter’, Ann
Intern Med, vol. 136, pp. 243-246.
Bryan, R.E., Krych, A.J., Carmichael, S.W., Viggiano, T.R., & Pawlina, W. (2005). Assessing professionalism in early medical education:
Experience with peer evaluation and self evaluation in the gross anatomy course. Ann Acad Med Singapore, 34:486-489.
Brown, D., Ferrill, M.J., Lloyd, L. (2009). The taxonomy of professionalism: reframing the academic pursuit of professional development.
American Journal of Pharmaceutical Education, 73(4):Article 68.
Christian, F., Pitt, D.F., Bond, J., Davison, P., & Gomes, A. (2008). Professionalism-connecting the past and the present and a blueprint for the
Canadian Association of General Surgeons. Can J Surg, 51: 88-91.
Cruess, R.L., Cruess, S.R., Steinert, Y. (2008). Teaching Medical Professionalism. Print Publication Press.
Cruess, S., Johnston, S., & Cruess, R. (2004). "Profession": A Working Definition for Medical Educators. Teaching
and Learning in Medicine, 16:74-76.
Cote, L., Leclere, H. (2000). How Clinical Teachers Perceive the Doctor-Patient Relationship and Themselves as Role Models. Academic
Medicine 75:1117-1124.
Fadar, J., Arnold, R., Coulehan, J., Pinkus, R.L., Meisel, A., & Schaffner, K. (1989). Evolution of clinical ethics teaching at the university of
Pittsburgh. Acad Med, 64:747-750.
Faiz, M.A. (2003). Medical Professionalism. The Healer, 10:1-4.

540 Abdus Salam et al. / Procedia - Social and Behavioral Sciences 60 ( 2012 ) 534 – 540
Feudtner, C., Christakis., D.A., & Christakis, N.A. (1994). Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical
environment and personal development. Acad Med, 69:670-679.
Freidson, E. (2001). Professionalism: The Third Logic. Chicago, IL: University of Chicago Press.
Gillespie, M. (2002). Student – teacher connection in clinical nursing education. J Adv Nurs, 37:566-576.
Goldie, J., Dowie, A., Cotton, P., Morrison, J. (2007). Teaching Professionalism in the Early Years of MedicalCurriculum: A Qualitative Study.
Medical Education. 41(6):610-617.
Hafferty, F.W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med, 69:861-871.
Haghdoost, A.A., & Shakibi, M.R. (2006). Medical student and academic staff perceptions of role models: an analytical cross sectional study.
BMC Med Educ, 6:9.
Hilton, S.R., Slotnick, H.B. (2005). Proto-professionalism: how professionalism occurs across the continuum of medical education. Med Educ,
39:58-65.
Inui, T.S. (2003). A flag in the wind: Educating for professionalism in Medicine. Association of American Medical Colleges, Washington, DC.
Irvine, D. (2003). The Doctor’s Tale. Oxford: Radcliffe Medical Press.
Kenny, N.P.O.C., Mann, K.V., MacLeod, H.M.A. (2003). Role modeling in physicians’ professional formation: reconsidering an essential but
untapped educational strategy. Academic Medicine, 78(12):1203-1210.
Kiker, M. (1973). Characterstics of the effective teacher. Nurs Outlook, 21:721-723.
Lloyd, B., & Bor, R. (1996). Communication Skills for Medicine. Churchill Livingstone.
Litzelman, D.K., & Cottingham, A.H. (2007). The new formal competency-based curriculum and informal curriculum at Indiana University
School of Medicine: overview and five year analysis. Acad Med, 82:410-421.
Maryland, B. (2002). Embedding Professionalism in Medical Education: Assessment as a tool for implementation. Report from an International
Conference Cosponsored by the Association of American Medical College (AAMC) and the National Board of Examiners (NBME), May
15-17.
Moloney, M.M. (1986). Professionalism of nursing: current issues and trends. JB Lippincott,Company, New York.
Nabishah, M., Farihah, H.S., Das, S., Salam, A., Siti Marium, B., Mohd Arif, K., Harlina, H.S., & Wan Zurinah, W.N. (2009). Problem based
learning facilitation: new challenges to higher education educators. International Medical Journal, 16: 243-246.
Nath, C., Schmidt, R., Gunel, E. (2006). Perceptions of professionalism vary most with educational rank and age. Journal of Dental Education,
70(8):825-834.
Pelaez, N.J., & Gonzalez, B.L. (2002). Sharing science: characteristics of effective scientist-teacher interactions Adv Physiol Educ, 26:158-167.
Patenaude, J., Niyonsenga, T., & Fafard, D. (2003). Changes in students’ moral development during medical school: a cohort study. CMAJ,
168:840-846.
Project Professionalism. (1995). Professionalism in medicine: issues and opportunities in the educational environment. Philadelphia, PA:
American Board of Internal Medicine.
Robert, F.M. (2001). Role models and the learning environment: essential elements in effective medical education. Acad Med. 76:432-434.
Reynolds, P.P. (1994). Reaffirming professionalism through the education community. Ann Intern Med.120(7):609-614.
Salam, A., Ahmad Faizal, M.P., Siti Harnida, M.I., Zulkifli, Z., Azian, A.L., Ng, S.P., Zauyah, Y., Ima Nirwana, S., Nabishah, M., Norhayati, M.
(2008a). UKM medical graduates’perception of their communication skills during housemanship. Medicine & Health, 3:54-58.
Salam, A., Zulkifli, Z., Azian, A.L., Ng, S.P., Ima Nirwana, S., Nabishah, M., Norhayati, M. (2008c). Assessment of medical graduates’
competencies. Annals Academy of Medicine, 37:814-816.
Salam, A., Rabeya, Y. (2009). Residential Field Site Training: Bangladesh Approach to Community-Based Education to Develop Generic Skills
in Tomorrows’ Doctors. Middle East Journal of Nursing, 3(5);22-27.
Salam, A., Rabeya, Y., Harlina, H.S., Nabishah, M. (2010b). Professionalism in medical education; A review, Eubios Journal of Asian and
International Bioethics 20(6):250-251.
Salam, A., Siraj, H.H., Mohamad, N., Das, S., Yousuf, R. (2011b). Bedside Teaching in Undergraduate Medical Education: Issues, Strategies and
New Models for Better Preparation of New Generation Doctors. Iranian Journal of Medical Sciences, 36(1):1-6.
Salam, A., Mohamad, N., Awang Besar, M.N. (2011c). Audit Upon Graduation: UKM House Officers’ Competencies. Procedia Social and
Behavioral Sciences, 18:460–463.
Sullivan, W.M. (1999). What is left to professionalism after managed care?. Hastings Center Rep, 29:7-13.
Swick, H.M. (2000). Toward a normative definition of medical professionalism. Acad Med, 75:612-616.
Swick, H.M., Szenas, P., Danoff, D., & Whitecomb, M.E. (1999). Teaching professionalism in undergraduate medical education. JAMA,
282:830-832.
Villegas-Alvarez, F., Polaco-Castillo, A.J., Gonzalez-Zamora, J.F., Gracia-Pineda, A.M., Madrid-Zavala, M.R. (2007). Surgical / medical
competencies, self-perception among a group of students recently graduated. Cirugia y cirujanos, 75:43-47.
Wilensky, H.L., (1964). The professionalism of every one. American Journal of Sociology, 70:143-144.