Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

Background  

Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.     

Osteopoikilosis and multiple exostoses caused by novel mutations in <Emphasis Type="Italic">LEMD3</Emphasis> and <Emphasis Type="Italic">EXT1</Emphasis> genes respectively - coincidence within one family

Background  

Osteopoikilosis is a rare autosomal dominant genetic disorder, characterised by the occurrence of the hyperostotic spots preferentially localized in the epiphyses and metaphyses of the long bones, and in the carpal and tarsal bones [1]. Heterozygous LEMD3 gene mutations were shown to be the primary cause of the disease [2]. Association of the primarily asymptomatic osteopokilosis with connective tissue nevi of the skin is categorized as Buschke-Ollendorff syndrome (BOS) [3]. Additionally, osteopoikilosis can coincide with melorheostosis (MRO), a more severe bone disease characterised by the ectopic bone formation on the periosteal and endosteal surface of the long bones [4–6]. However, not all MRO affected individuals carry germ-line LEMD3 mutations [7]. Thus, the genetic cause of MRO remains unknown. Here we describe a familial case of osteopoikilosis in which a novel heterozygous LEMD3 mutation coincides with a novel mutation in EXT1, a gene involved in aetiology of multiple exostosis syndrome. The patients affected with both LEMD3 and EXT1 gene mutations displayed typical features of the osteopoikilosis. There were no additional skeletal manifestations detected however, various non-skeletal pathologies coincided in this group.     

What Qualities Do Medical School Applicants Need to Have? - Secondary Publication

Purpose

Doctors are asked to play the roles of both a healer and a professional. In dealing with this inherent demand, we should first ask ourselves if we are selecting students who show traits that would enable them to become a good doctor. The primary concern of this study was to identify the core elements of medical professionalism that will develop into professional competence that we should be sought in medical school applicants.

Materials and Methods

One hundred-six responses from the Delphi survey done by medical school professors and 230 completed questionnaires from medical students were used for analysis. We also set out to analyze the level of medical professionalism in newly entering medical students using a 5-point Likert scale.

Results

Of the 27 elements of medical professionalism examined, the most important core element was thought to be ''life-long learning skills''. The level of professionalism in Korean medical students was mostly assessed to be less than the 3.0 mean score given by the professors. Medical students tended to rate themselves higher than did the professors for their level of medical professionalism.

Conclusion

Medical professionalism can be categorized into three domains; professional knowledge, professional skills, and professional attitude. For the prominent differences in the recognition of the levels of professionalism elements in medical students by students and professors, further studies investigating the reasons for discrepancy are needed.     

Cyclic changes in gene expression induced by Peg-interferon alfa-2b plus ribavirin in peripheral blood monocytes (PBMC) of hepatitis C patients during the first 10 weeks of treatment

Background and Aims  

This study determined the kinetics of gene expression during the first 10 weeks of therapy with Pegylated-interferon-alfa2b (PegIntron™) and ribavirin (administered by weight) in HCV patients and compared it with the recently completed Virahep C study [1, 2] in which Peginterferon-alfa2a (Pegasys™) and ribavirin were administered.     

Are There Gaps between Medical Students and Professors in the Perception of Students' Professionalism Level? - Secondary Publication

Purpose

The implementation of medical professionalism in education and evaluation is a recent trend in medical education. Although many studies on the subject have been carried out, they have generally been not focused specifically on the level of medical student professionalism, and the perception gaps between medical students and professors on this topic remain unresolved. This study attempts to determine whether such gaps exist.

Materials and Methods

Two hundred fifty fourth-year medical students and 53 professors who were randomly selected from 41 medical schools were asked to complete a survey on the level of the professionalism of medical students. Using 31 core professionalism elements that are required for Korean medical students, students self-assessed their level of professionalism, and professors evaluated the professionalism level of medical students who were about to graduate.

Results

Of the 31 core elements, significant perception gaps were found in 28 elements. The three domains into which the 31 core elements were divided - professional knowledge, professional skills, and professional attitude - all contained perception gaps, and professors'' ratings generally were higher than those of the students, a noteworthy observation.

Conclusions

Medical professors need to encourage their students to elevate their professionalism. Furthermore, what the faculty think that they have taught regarding professionalism may not be fully assimilated by students. Therefore, further research is essential to determine the cause of such perceptional differences.     

Patient accessible electronic health records: exploring recommendations for successful implementation strategies

Background

Providing patients with access to their electronic health records offers great promise to improve patient health and satisfaction with their care, as well to improve professional and organizational approaches to health care. Although many benefits have been identified, there are many questions about best practices for the implementation of patient accessible Electronic Health Records (EHRs).

Objectives

To develop recommendations to assist health care organizations in providing patients with access to EHRs in a meaningful, responsible, and responsive manner.

Methods

A Patient Accessible Electronic Health Record (PAEHR) Workshop was held with nationally and internationally renowned experts to explore issues related to providing patient access to the EHR and managing institutional change.

Results

The PAEHR Workshop was attended by 45 participants who discussed recommendations for the implementation of patient accessible EHRs. Recommendations were discussed under four subject domains: (1) providing patient access to the EHR, (2) maintaining privacy and confidentiality related to the PAEHR, (3) patient education and navigation of the PAEHR, and (4) strategies for managing institutional change. The discussion focused on the need for national infrastructure, clear definitions for privacy, security and confidentiality, flexible, interoperable solutions, and patient and professional education. In addition, there was a strong call for research into all domains of patient accessible EHRs to ensure the adoption of evidence-based practices.

Conclusions

Patient access to personal health information is a fundamental issue for patient engagement and empowerment. Health care professionals and organizations should consider the potential benefits and risks of patient access when developing EHR strategies. Flexible, standardized, and interoperable solutions must be integrated with outcomes-based research to activate effectively patients as partners in their health care.     

A comparison between exocytic control mechanisms in adrenal chromaffin cells and a glutamatergic synapse

It has been known since the work of Katz and collaborators in the early 1950s that an increase in intracellular Ca⁺⁺ concentration ([Ca⁺⁺]) is the immediate trigger for neurotransmitter release [1]. Later work has shown that, next to Ca⁺⁺, many other signaling pathways, particularly via cyclic AMP, modulate the release of both neurotransmitters and hormones [2–5]. However, regulated secretion is a multistep process and the signaling mechanisms involved act at many stages. Biochemical and traditional electrophysiological techniques very often cannot distinguish whether a change in secretion is caused by regulation of ion channels, vesicle trafficking, or the exocytic process itself. My laboratory has made an effort to dissect the stimulus secretion pathway by developing assays in chromaffin cells (for catecholamine release) and at a glutamatergic central nervous synapse (the calyx of Held, a component of the auditory pathway), which permit the study of secretion in single cells under voltage clamp conditions [6, 7]. This enables us to clearly distinguish between consequences of changes in electrical signaling, from those regarding the process of vesicle recruitment or the process of exocytosis.     

Exploring reflective 'critical incident' documentation of professionalism lapses in a medical undergraduate setting

Background  

Measuring professionalism in undergraduate medical students is a difficult process, and no one method has currently emerged as the definitive means of assessment in this field. Student skills in reflection have been shown to be highly important in the development of professional behaviours. By studying student reflections on lapses in professional judgement, recorded as 'critical incidents', it is possible to explore themes which are significant for the development of professional behaviour in an undergraduate setting.     

Building the national health information infrastructure for personal health, health care services, public health, and research

Background  

Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach.     

Knowledge and beliefs concerning evidence-based practice amongst complementary and alternative medicine health care practitioners and allied health care professionals: A questionnaire survey

Background  

Evidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency.     

A curriculum to teach medical students to care for people with disabilities: development and initial implementation

Background  

Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire.     

Emotional intelligence and perceived stress in healthcare students: a multi-institutional, multi-professional survey

Background  

Emotional intelligence (EI) is increasingly discussed as having a potential role in medicine, nursing, and other healthcare disciplines, both for personal mental health and professional practice. Stress has been identified as being high for students in healthcare courses. This study investigated whether EI and stress differed among students in four health professions (dental, nursing, graduate mental health workers, medical) and whether there was evidence that EI might serve as a buffer for stress.     

Opportunities and barriers for implementation of integrated TB and HIV care in lower level health units: experiences from a rural western Ugandan district

Background

As countries with a high burden of TB and HIV roll out integrated TB/HIV care, there is need to assess possibility of lower level health units treating TB to provide integrated TB/HIV care.

Objective

To determine barriers and opportunities for provision of integrated TB/HIV care in lower level health units offering TB treatment in Mbarara district, Uganda.

Methods

Conducted key informant interviews, interviewed health workers and observed services offered.

Results

22 health units were assessed and 88 health workers were interviewed. Of the 18 health units mandated to offer laboratory services, 55.6% and 38.9% were able to offer rapid HIV-testing and ZN staining respectively. Understaffing, lack of capacity to diagnose HIV and TB, lack of guidelines to inform care options of TB/HIV co-infected patients and insufficient knowledge and skills among health workers towards provision of integrated TB/HIV care were mentioned as barriers to provision of integrated TB/HIV services.

Conclusion

To offer integrated TB/HIV services at lower level health units currently offering TB stand alone services, there is need to address gaps in knowledge and skills among health workers, laboratory diagnostics, staffing levels, medical supplies and infrastructure.     

A scenario analysis of the future residential requirements for people with mental health problems in Eindhoven

Background  

Despite large-scale investments in mental health care in the community since the 1990 s, a trend towards reinstitutionalization has been visible since 2002. Since many mental health care providers regard this as an undesirable trend, the question arises: In the coming 5 years, what types of residence should be organized for people with mental health problems? The purpose of this article is to provide mental health care providers, public housing corporations, and local government with guidelines for planning organizational strategy concerning types of residence for people with mental health problems.     

Transforming medical professionalism to fit changing health needs

Background  

The professional organization of medical work no longer reflects the changing health needs caused by the growing number of complex and chronically ill patients. Key stakeholders enforce coordination and remove power from the medical professions in order allow for these changes. However, it may also be necessary to initiate basic changes to way in which the medical professionals work in order to adapt to the changing health needs.     

Patients’ perceptions of health system responsiveness in ambulatory care in Germany

Objective

To identify overall levels of health system responsiveness and the associations with social determinants for ambulatory health care in Germany from a user perspective.

A scoping review of medical professionalism research published in the Chinese language

Background

The Chinese Medical Doctors Association (CMDA) adopted the Charter of Medical Professionalism in the New Millennium (Charter) and published the Chinese Medical Doctor Declaration (Declaration). This is an important step to re-building medical professionalism in China at a time when the commercialization of health care has led to a decline in physician accountability and public trust in the profession. In response, authors have begun to examine and promote medical professionalism in China. This study aims to present the key research themes, identify research gaps and offer recommendations from reviewing the increasing pool of Chinese-language literature on medical professionalism.

Methods

A scoping review of Chinese language papers was conducted using the China National Knowledge Infrastructure (including China Academic Journals Full-text Database, China Doctoral Dissertations Full-text Database, Masters’ Theses Full-text Database, China Core Newspapers Full-text Database, and China Yearbooks Full-text Database) (CNKI) database.

Results

Four major research themes were identified in Chinese discourse: (1) teaching professionalism, (2) practicing professionalism, (3) conceptualizing professionalism and (4) assessing professionalism. Overall, authors were concerned with the cultivation of humanism in physicians and emphasized the importance of communication skills to improve the physician-patient relationship in China. They explored the role of traditional Chinese values, such as Confucian and Taoist values, as well as the Communist Party’s political values, in promoting professional behaviour.

Conclusions

Authors demonstrate increasing interest in medical professionalism in China. The literature is of variable quality and further empirical studies are required in order to evaluate teaching interventions and guide professionalism assessment. A common professionalism framework is absent and could be developed with consideration to China’s socio-cultural context.

     

Exploring barriers and enablers to the delivery of Making Every Contact Count brief behavioural interventions in Ireland: A cross-sectional survey study

Objectives

The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation.

Design

Online cross-sectional survey design.

Methods

Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER).

Results

Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R² = .34), the significant enablers of intervention delivery were ‘professional role’ (OR = 1.86 [1.10, 3.15]) and ‘intentions/goals’ (OR = 4.75 [1.97, 11.45]); significant barriers included ‘optimistic beliefs about consequences’ (OR = .41 [.18, .94]) and ‘negative emotions’ (OR = .50 [.32, .77]). In the multiple linear regression (R² = .29), the significant enablers of frequency of MECC delivery were ‘intentions/goals’ (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were ‘negative emotions’ (b = −4.74, p = .04) and ‘barriers to prioritisation’ (b = −5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: ‘intentions and goals’, ‘barriers to prioritisation’, ‘environmental resources’, ‘beliefs about capabilities’, ‘negative emotions’ and ‘skills’.

Conclusion

Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization.     

The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

Background

The rising impact of social media on the private and working lives of health care professionals has made researchers and health care institutions study and rethink the concept and content of medical professionalism in the digital age. In the last decade, several specific policies, original research studies, and comments have been published on the responsible use of social media by health care professionals. However, there is no systematic literature review that analyzes the full spectrum of (1) social media–related challenges imposed on medical professionalism and (2) social media–related opportunities to both undermine and improve medical professionalism.

Objective

The aim of this systematic qualitative review is to present this full spectrum of social media–related challenges and opportunities.

Methods

We performed a systematic literature search in PubMed (restricted to English and German literature published between 2002 and 2011) for papers that address social media–related challenges and opportunities for medical professionalism. To operationalize “medical professionalism”, we refer to the 10 commitments presented in the physicians’ charter “Medical professionalism in the new millennium” published by the ABIM Foundation. We applied qualitative text analysis to categorize the spectrum of social media–related challenges and opportunities for medical professionalism.

Results

The literature review retrieved 108 references, consisting of 46 original research studies and 62 commentaries, editorials, or opinion papers. All references together mentioned a spectrum of 23 broad and 12 further-specified, narrow categories for social media–related opportunities (n=10) and challenges (n=13) for medical professionalism, grouped under the 10 commitments of the physicians’ charter.

Conclusions

The accommodation of the traditional core values of medicine to the characteristics of social media presents opportunities as well as challenges for medical professionalism. As a profession that is entitled to self-regulation, health care professionals should proactively approach these challenges and seize the opportunities. There should be room to foster interprofessional and intergenerational dialogue (and eventually guidelines and policies) on both challenges and opportunities of social media in modern health care. This review builds a unique source of information that can inform further research and policy development in this regard.