Taiwanese and Sri Lankan students' dimensions and discourses of professionalism.

Lynn V Monrouxe,Madawa Chandratilake,Katherine Gosselin,Ming-Jung Ho,Charlotte E Rees

doi:10.1111/medu.13291

Abstract

ContextThe definition of medical professionalism poses a challenge to global medical educators. This is especially pronounced in settings where professionalism frameworks developed in the west are transferred into different cultures. Building upon our previous study across Western contexts, we examine Taiwanese and Sri Lankan medical students’ conceptualisations of professionalism in terms of what professionalism comprises (i.e. dimensions) and how it is linguistically framed (i.e. discourses).MethodsA qualitative group interview study was undertaken comprising 26 group interviews with 135 participants from one Taiwanese (n = 64; Years 4–7) and one Sri Lankan medical school (n = 71; Years 2–5). Through thematic framework analysis we examined the data for explicit dimensions of professionalism. Through discourse analysis we identified how participants constructed professionalism linguistically (discourses).ResultsThirteen common dimensions across Taiwanese and Sri Lankan talk were identified, with the dimensions (contextual, integration and internalised self) being identified only in Sri Lankan data. Professionalism as knowledge and patient‐centredness were dominant dimensions in Taiwan; in Sri Lanka, attributes of the individual and rules were dominant dimensions. Participants in both countries used four types of discourses previously identified in the literature. Individual and interpersonal discourses were dominant in Taiwanese talk; the collective discourse was dominant in Sri Lankan talk. Findings were compared with our previous data collected in Western contexts.ConclusionsDespite some overlap in the dimensions and discourses identified across both this and Western studies, Taiwanese and Sri Lankan students’ dominant dimensions and discourses were distinct. We therefore encourage global medical educators to look beyond a one‐size‐fits‐all approach to professionalism, and to recognise the significance of context and culture in conceptualisations of professionalism.

Highlights

IntroductionBecause of high-profile transgressions of professionalism, public expectations of the medical profession have been changing.[1,2] As a result, especially in the Western world, the discourse regarding fitness-to-practice in medicine has been transformed from one of competence (i.e. skills based) to one of being a professional (i.e. an embodied identity).[3] This has led to professionalism in the Western world being an explicit component of education and practice.[4,5,6] As such, this requires us to understand more fully what comprises professionalism.[7] This transformation has had a major influence across the world, with many countries adopting Western conceptualisations of professionalism wholesale or with minor modifications.[8,9,10] Professionalism, is increasingly viewed as a socially-constructed phenomenon: one that is impacted by social, cultural and economic factors.[7] many believe that the translation of Western professionalism concepts across the world should attend to national cultural differences.[11,12,13] Our study focuses on medical students’ explicit conceptualisations of professionalism across both Eastern (Taiwan and Sri Lanka) and Western (UK and Australia) cultures
Because of high-profile transgressions of professionalism, public expectations of the medical profession have been changing.[1,2] As a result, especially in the Western world, the discourse regarding fitness-to-practice in medicine has been transformed from one of competence to one of being a professional.[3]
Individual and interpersonal discourses were dominant in Taiwanese talk; the collective discourse was dominant in Sri Lankan talk

Summary

Introduction

Because of high-profile transgressions of professionalism, public expectations of the medical profession have been changing.[1,2] As a result, especially in the Western world, the discourse regarding fitness-to-practice in medicine has been transformed from one of competence (i.e. skills based) to one of being a professional (i.e. an embodied identity).[3] This has led to professionalism in the Western world being an explicit component of education and practice.[4,5,6] As such, this requires us to understand more fully what comprises professionalism.[7] This transformation has had a major influence across the world, with many countries adopting Western conceptualisations of professionalism wholesale or with minor modifications.[8,9,10] Professionalism, is increasingly viewed as a socially-constructed phenomenon: one that is impacted by social, cultural and economic factors.[7] many believe that the translation of Western professionalism concepts across the world should attend to national cultural differences.[11,12,13] Our study focuses on medical students’ explicit conceptualisations of professionalism across both Eastern (Taiwan and Sri Lanka) and Western (UK and Australia) cultures

Objectives

Methods

Results

Conclusion