Unprofessional Research Articles

Factors Influencing the Implementation of a Hospital-wide Intervention to Promote Professionalism and Build a Safety Culture: A Qualitative Study

There is widespread recognition that creating a safety culture supports high-quality health care. However, the complex factors affecting cultural change interventions are not well understood. This study examines factors influencing the implementation of an intervention to promote professionalism and build a safety culture at an Australian hospital. The study was completed midway into the three-year intervention and involved collecting qualitative data from two sources. First, face-to-face interviews were conducted pre- and mid-intervention with a purposely selected sample. Second, a survey with three open-ended questions was completed one year into the intervention by clinical and patient support staff. Data from interviews and survey questions were analyzed using a combination of inductive and deductive approaches. A total of 25 participants completed preintervention interviews, and 24 took part mid-intervention. Of the 2,047 staff who completed the survey (61% response rate), 59.1% of respondents answered at least one open-ended question. Multiple interrelated factors were identified as enhancing intervention implementation. These include sustaining a favorable implementation climate, leaders consistently demonstrating behaviors that support a safety culture, increasing compatibility of working conditions with intervention aims, building confidence in systems to address unprofessional behaviors, and responding to evolving needs. Strengthening safety culture remains an enduring challenge, but this study yields valuable insights into factors influencing implementation of a multifaceted behavior change intervention. The findings provide a basis for practical strategies that health care leaders seeking cultural improvements can employ to enhance the delivery of similar interventions and address potential impediments to success.

Incivility behaviours exhibited by nursing students: clinical educators’ perspectives of challenging teaching and assessment events in clinical practice

Background: The increase in the frequency and severity of student incivility and unprofessional behaviours in clinical education is of concern. Aim: To determine the types and frequency of incivility and unprofessional student behaviours, triggers for disruptive behaviour and situations that clinical educators find challenging.An exploratory study using online surveys and interviews investigated perspectives of 71 respondents from two Schools of Nursing within Australia and one in the United States.Results: Almost all participants had experienced student incivility and unprofessional behaviours in the previous 12 months. A significant antecedent for these behaviours was students receiving feedback perceived to be negative. Clinical educators with experience and qualifications in education reported more incidents and frequency of student incivility and unprofessional behaviour.Conclusions: Incivility and unprofessionalism is commonly reported. It is recommended that students and faculty act proactively to prevent these behaviours, and that focused training and support to prevent, reduce and manage incivility and unprofessionalism is implemented.

Residency Interview Experiences in Oral and Maxillofacial Surgery Differ by Gender and Affect Residency Ranking

Resident interview experiences are crucial for applicants when ranking programs. The purpose of the present study was to evaluate the interview experience among current oral and maxillofacial surgery (OMS) residents to determine the factors that influenced their selection and ranking of training programs and whether these experiences differed between women and men. We conducted a cross-sectional survey of OMS residents in 2018. The 12-question survey included demographics, reasons for selecting an interview and ranking programs, and positive and negative experiences during the interviews. Logistic regression models were constructed to evaluate the predictors of unprofessional or negative experiences. A total of 1134 surveys were emailed, with 165 completed questionnaires (14.6%) returned by 35 women (21.2%) and 130 men (78.8%). Their average age was 30.8years (range, 25 to 42). The racial/ethnic distribution was as follows: white, 75.8%; Asian, 15.8%; and other, 8.4%. Of the 165 respondents, 52% were in MD and 48% in non-MD programs. The top factors in selecting an institution at which to interview were clinical scope and volume, and the reason for ranking a program high was resident friendliness, which was similar among the female and male respondents. Unprofessional behavior or negative experiences were reported by 62 respondents (38%) and occurred by both faculty and residents and during both interviews and social events. Demeaning behavior toward the applicant, residents, and colleagues was the most common negative experience overall, with the women experiencing more gender-specific inappropriate behavior. Female respondents and those who were in dual-degree programs were 2.4 and 2.1 times more likely to experience unprofessional conduct than their peers, respectively (P=.03). Female and male residents were influenced by the same factors when selecting interviews and ranking residency programs. Unprofessional and inappropriate conduct was reported by 38% of the respondents. Women and dual-degree respondents were 2.4 and 2.1 times more likely to experience unprofessionalism during interviews, respectively. This might have contributed to the low number of current female OMS residents.

Research on the development status and suggestions of traditional Chinese medicine service trade in the United Arab Emirates

The United Arab Emirates (UAE) is an important partner in China's The Belt and Road initiative. It has a broad prospect of pharmaceutical market which is an important market for traditional Chinese medicine (TCM)’s development. TCM has existed in UAE’s market in a short time, so TCM service trade in UAE has the shortcomings of small scale of the consumption and a large number of unprofessional practitioners. But it also has advantages of the good traditional medicine’s inter-communion between two countries and the university jointly organization of building hospitals of TCM. This article analysizes the market opportunities and potential risks traditional Chinese medicine in UAE’s market, and puts forward to remote technical power development, medical tourism to stimulate consumption abroad, strengthens the cultural and research communication, sets up guidance department to accelerate the development process of Chinese medicine. Key words: International cooperation; Traditional Chinese medicine; Service trade; The United Arab Emirates; Medical tourism; History of medical exchange between China and foreign countries

Practical tips for teaching academic integrity in the digital age.

This article was migrated. The article was marked as recommended. Background: Medical education, as with other areas of healthcare education, is susceptible to cheating, with national and international examples cited in the literature. There are documented examples in the lay press, but limited scholarly activity in the field, which can be a challenging area to research and tackle. We have begun to explicitly address academic integrity within our undergraduate curriculum, including a focus on plagiarism, self-plagiarism, and covert sharing of questions. We believe this is an important curricular topic as exhibiting unprofessional behaviours can correlate with professional practice and can potentially have implications for practitioners and patients. Aim: To present 12 tips on teaching academic integrity in the digital age to medical students. Method: The tips presented are based on our experiences of teaching academic digital integrity to medical students, primarily in the form of a scenario based quiz. We do also extrapolate from content on academic integrity elsewhere within our professionalism syllabus. Results: The tips suggest that early, contemporary and contextualised material that is co-produced with students may offer a useful prophylactic approach to teaching about academic integrity. Conclusions: The principles presented could be adapted to other healthcare students and settings, including postgraduate education.

Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients

For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may undermine a culture of safety, threaten teamwork, and thereby increase the risk for medical errors and surgical complications. To test the hypothesis that patients of surgeons with higher numbers of reports from coworkers about unprofessional behaviors are at greater risk for postoperative complications than patients whose surgeons generate fewer coworker reports. This retrospective cohort study assessed data from 2 geographically diverse academic medical centers that participated in the National Surgical Quality Improvement Program (NSQIP) and recorded and acted on electronic reports of safety events from coworkers describing unprofessional behavior by surgeons. Patients included in the NSQIP database who underwent inpatient or outpatient operations at 1 of the 2 participating sites from January 1, 2012, through December 31, 2016, were eligible. Patients were excluded if they were younger than 18 years on the date of the operation or if the attending surgeon had less than 36 months of monitoring for coworker reports preceding the date of the operation. Data were analyzed from August 8, 2018, through April 9, 2019. Coworker reports about unprofessional behavior by the surgeon in the 36 months preceding the date of the operation. Postoperative surgical or medical complications, as defined by the NSQIP, within 30 days of the operation. Among 13 653 patients in the cohort (54.0% [7368 ] female; mean [SD] age, 57 [16] years) who underwent operations performed by 202 surgeons (70.8% [143] male), 1583 (11.6%) experienced a complication, including 825 surgical (6.0%) and 1070 medical (7.8%) complications. Patients whose surgeons had more coworker reports were significantly more likely to experience any complication (0 reports, 954 of 8916 [10.7%]; ≥4 reports, 294 of 2087 [14.1%]; P < .001), any surgical complication (0 reports, 516 of 8916 [5.8%]; ≥4 reports, 159 of 2087 [7.6%]; P < .01), or any medical complication (0 reports, 634 of 8916 [7.1%]; ≥4 reports, 196 of 2087 [9.4%]; P < .001). The adjusted complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports (P = .05). Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient's operation appeared to be at increased risk of surgical and medical complications. These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients' risk for adverse outcomes.

Unethical behavior and professionalism among medical students in a private medical university in Malaysia

BackgroundEthical behavior and professionalism is an ideal characteristic required of medical students and included as ‘must achieve’ and critical aspect of medical students’ curriculum. This study proposes to determine the perceived unethical and unprofessional behavior among medical students in a private medical university from year 1 to year 5 of the medical curriculum.MethodsA cross–sectional study was conducted among year 1 to year 5 medical students in a private medical university. A self-administered questionnaire was used with the 3 major domains of professionalism and ethics i.e. discipline plagiarism and cheating.ResultsA total of 464 respondents responded to the survey and they included medical students from year 1 and year 2 (pre-clinical) and years 3–5 (clinical years). Majority of the students, 275 (59.2%) answered that they had not seen any form of unethical behavior among other students. The females seem to have a larger number 172(63%) among the same gender compared to the males. Majority 352 (75%) of them had not heard of the ‘Code of Professional Conduct by the Malaysian Medical Council’. About fifty three (53.1%) of the students answered that the training was sufficient.ConclusionsThis study showed that the perception of unethical behavior was 58.8% in the 1st year (pre-clinical) and it increased to 65.2% in the 5th year (clinical). The 3 main discipline issues were students do not show interest in class (mean 2.9/4), they are rude to other students (mean 2.8/4) and talking during class (mean 2.6/4). Despite the existence of unethical behavior among the students majority of them (71.7%) claimed that they had adequate training in ethics and professionalism. It is proposed that not only the teaching of ethics and professionalism be reviewed but an assessment strategy be introduced to strengthen the importance of professionalism and ethics.

PERCEPTIONS AND ATTITUDE ON USING SOCIAL MEDIA RESPONSIBLY: TOWARD SOCIAL MEDIA LITERACY IN NURSING EDUCATION

Background: As future professionals, nursing students are expected to exhibit online professionalism and to be responsible users of social media. However, the rapid sharing of information on social media exposes nursing students to the risk and danger of spreading unprofessional behaviors like breaches of privacy and confidentiality.&#x0D; Objective: This study looked into the nursing students’ perceptions and attitude toward responsible use of social media.&#x0D; Methods: A descriptive cross-sectional research design was utilized and participated by 298 nursing students in a College of Nursing in Iloilo City, Philippines. The Responsible Use of Social Media Attitude Scale (RUSMAS) created by the researchers was used to collect the data.&#x0D; Results: Findings indicated that nursing students widely use social media and that nursing students had good perceptions and had positive attitude toward responsible use of social media. A significant difference was found in the attitude of nursing students when grouped according to year level.&#x0D; Conclusion: Social media continue to gain interest among nursing students and using it responsibly must be continuously upheld. Academic nursing institutions should develop approaches promoting social media literacy in nursing education.

Social media usage and online professionalism among registered nurses: A cross-sectional survey

BackgroundOwing to its convenience and easy accessibility, social media is increasingly popular among healthcare professionals and has become a useful tool in the healthcare industry. Doctors’ social media use patterns and online professionalism have been thoroughly studied. Various unprofessional behaviors such as excessive self-disclosure, violations of patient privacy and improper social media posts, were observed. However, studies exploring nurses’ social media use and online professionalism are lacking. ObjectivesThe objective of this study was to understand the social media use and online professionalism of Chinese registered nurses. DesignA cross-sectional survey was adopted. SettingsEight nursing conferences and one continuing-education program that took place in Sichuan, China. ParticipantsConvenience sampling was applied to select nurses who had obtained their Chinese nursing certificates, who were aged 18 years and above, and who worked in clinical settings. The final sample consisted of 658 registered nurses. MethodsData were collected through the on-site distribution of an anonymous researcher-designed questionnaire. The questionnaire consisted of 41 items that focused on demographic and professional information, social media use and online professionalism. Medians, averages and percentages were used to describe the social media use patterns and online professionalism of Chinese registered nurses. ResultsAll participants in this study were social media users and 84.5% of them believed that social media had positively influenced their clinical practice. WeChat was the most frequently used form of social media, which was used among 93.5% of the subjects. Common reasons for social media use included receiving messages from work, networking, receiving news and relaxing. Approximately 56% of the participants spent one to three hours on social media daily. Most of the participants had reposted medical knowledge on social media and had subscribed to at least one medical social media account. Additionally, 67.2% of the sample disclosed that they “often” communicate work-related information with colleagues via social media. Roughly 50% of the sample insisted that their facilities had social media guidelines. Registered nurses’ professionalism was also assessed. Around half of the participants had received “friend request” from patients, while 63.5% of the sample acknowledged that there were no patients on their most frequently used social media platforms. About 7.6% of the respondents had “sometimes” posted identifiable patient information, which was much lower than the reported 32.5% rate of witnessing colleagues’ disclosure of identifiable patient information. Fully 50.3% of the participants indicated that they had witnessed improper posts by colleagues.

Sexual Harassment in the Workplace: Case Study of the Nigerian Legal Sector

Sexual Harassment has been a habitual phenomenon among legal professionals. Consequently, “suffering and smiling” is the concealed solution to this challenge due to the importance of livelihood and career development. This study seeks to examine the prevalence of sexual harassment within the Nigerian legal profession, whether there is need for the victims to be protected and provided with legal structure to confidently report issue of sexual harassment, and whether there is a need for domestic law for the society. Empirical and descriptive research methods were adopted, 561 Nigerian lawyers were surveyed using a structured questionnaire. Data were collected and analyzed using frequencies, chi-square, chart, regression and correlation analysis. It revealed that there is no adequate social structure for addressing sexual harassment and prolonged exposure to sexual harassment has disguised its true effect on the victims. Thus, there is a need for professional regulation to combat sexual harassment among the lawyers. Keywords: Behavioural adaptation; Nigerian legal professionals; National Industrial Court of Nigeria; Unprofessional behaviour: Sexual harassment in the workplace DOI : 10.7176/JLPG/86-13 Publication date :June 30 th 2019

How accessible are you? A hospital-wide audit of the accessibility and professionalism of Facebook profiles.

Introduction Social media is an integral part of modern society and is increasingly being used by patients and clinical staff alike. The General Dental Council and most employers have social media guidelines to ensure employees use social media responsibly and do not bring their organisations into disrepute.Aims To establish the accessibility of Facebook profiles of the staff and students at Eastman Dental Hospital (EDH) and to assess compliance with the latest social media guidance from the General Dental Council as well as the employing trust and university.Design and setting A hospital-wide prospective audit conducted from January to March 2018 at Eastman Dental Hospital.Gold standard One-hundred percent compliance with: a) General Dental Council (GDC); b) University College London (UCL); and c) University College London Hospitals (UCLH) social media policies.Materials and methods The names of all clinical staff/students at EDH were searched for on Facebook using a dummy profile account, to simulate a member of the public. The profiles were assessed for the accessibility of personal information, affiliations to UCL/UCLH, personal views, social networking and conduct.Results A total of 219 out of 440 profiles (50%) were identified and were accessible to varying degrees. Many accessible profiles had a profile picture and personal information visible such as gender and location. No violations of patient confidentiality were seen. Overall, 6% (n = 14) and 2% (n = 4) of profiles displayed unprofessional behaviour and substance abuse, respectively.Discussion This audit highlighted Eastman Dental Hospital's compliance to local and national social media policies.Conclusion It was not possible to identify all staff/students through the Facebook search function. No serious professional misconduct was identified, however a small minority displayed unprofessional behaviour.

A Narrative Review of the Evidence Supporting Factors Used by Residency Program Directors to Select Applicants for Interviews.

Residency applicants feel increasing pressure to maximize their chances of successfully matching into the program of their choice, and are applying to more programs than ever before. In this narrative review, we examined the most common and highly rated factors used to select applicants for interviews. We also examined the literature surrounding those factors to illuminate the advantages and disadvantages of using them as differentiating elements in interviewee selection. Using the 2018 NRMP Program Director Survey as a framework, we examined the last 10 years of literature to ascertain how residency directors are using these common factors to grant residency interviews, and whether these factors are predictive of success in residency. Residency program directors identified 12 factors that contribute substantially to the decision to invite applicants for interviews. Although United States Medical Licensing Examination (USMLE) Step 1 is often used as a comparative factor, most studies do not demonstrate its predictive value for resident performance, except in the case of test failure. We also found that structured letters of recommendation from within a specialty carry increased benefit when compared with generic letters. Failing USMLE Step 1 or 2 and unprofessional behavior predicted lower performance in residency. We found that the evidence basis for the factors most commonly used by residency directors is decidedly mixed in terms of predicting success in residency and beyond. Given these limitations, program directors should be skeptical of making summative decisions based on any one factor.

Identifying Medical Student Mistreatment in the Obstetrics and Gynecology Clerkship

To characterize the mistreatment identified within the University of Michigan's Obstetrics and Gynecology (Ob/Gyn) clerkship and compare the rates of mistreatment to that of other clerkships in an effort to improve the learning environment. This is a retrospective cohort study looking at multiple sources of data from 2015 to 2018 about student mistreatment including end-of-rotation and teaching evaluations completed by students, as well as an online reporting system available to medical students. For evaluations, students were asked to rate their agreement with statements on a 5-point Likert scale (1 = strongly disagree, to 5 = strongly agree). Narrative comments were also solicited and evaluated. University of Michigan Medical School and Michigan Medicine Ob/Gyn Department, Ann Arbor, Michigan. A total of 513 students rotated through the Ob/Gyn clerkship between 2015 and 2018 and were asked to complete evaluations. Five hundred and five of the 513 students completed evaluations between 2015 and 2018. In response to the statement, "Students are treated in a professional/respectful manner in this clerkship," the Ob/Gyn clerkship's mean scores on a 5-point scale were 4.45 (in 2015-2016), 4.52 (in 2016-2017), and 4.27 (in 2017-2018). These means, as well as the means to 3 other professionalism questions, were lower than the range of 4.42 to 4.84 for all other third-year clerkships over this time. The mean scores were also lower for Ob/gyn when compared to the Surgery clerkship. A total of 32 narrative comments were submitted by students between 2015 and 2017 related to mistreatment or unprofessional behavior. Frequent themes included students being treated as "stupid" or discouraged from asking questions (8 comments), being treated in an unprofessional manner by staff (7 comments), feeling ignored or marginalized by faculty (4 comments), and faculty unprofessional behavior toward others (4 comments). Students on the Ob/Gyn clerkship reported a higher rate of mistreatment compared to other clerkships. Efforts are being made by the Ob/Gyn department to communicate these data on mistreatment to educators in order to improve the Ob/Gyn culture and learning environment for medical students.

Role Modeling to Teach Communication and Professionalism in Prelicensure Nursing Students

Role modeling therapeutic communication and professionalism is an active teaching strategy for prelicensure nursing students. This role modeling strategy supplements theoretical content taught in the classroom and assists students in formulating concrete examples rather than abstract ideas. A mixed method, nonexperimental descriptive study was conducted to identify various therapeutic and nontherapeutic communication patterns as well as professional and unprofessional behaviors exhibited in a simulated patient scenario.

Do Uncivil Nursing Students Become Uncivil Nurses? A National Survey of Faculty.

Faculty frequently express anecdotal concerns that poorly behaving nursing students will go on to behave poorly as licensed nurses. Unfortunately, no empirical evidence exists to support or refute these concerns. The purpose of this study was to determine what knowledge faculty have of poorly behaving nursing students who also behaved poorly in subsequent practice. A cross-sectional, descriptive design using online survey methods was used to gather data from a national sample of nurse educators. Approximately 37 percent of respondents reported having personal knowledge of a former poorly behaving student who went on to display poor behavior as a licensed provider; 71 percent reported that at least one student had graduated in the previous year whom they thought should not have graduated based on unprofessional behaviors. Study findings provide troubling evidence that at least some poorly behaving students continue to demonstrate unprofessional behavior as licensed nurses.

Key stakeholder opinions for a national learner education handover

BackgroundSharing information about learners during training is seen as an important component supporting learner progression and relevant to patient safety. Shared information may cover topics from accommodation requirements to unprofessional behavior. The purpose of this study was to determine the views of key stakeholders on a proposed national information sharing process during the transition from undergraduate to postgraduate medical education in Canada, termed the Learner Education Handover (LEH).MethodKey stakeholder groups including medical students, resident physicians, residency program directors, medical regulatory authority representatives, undergraduate medical education deans, student affairs leaders, postgraduate medical education deans participated in focus groups conducted via teleconference. Data were transcribed and coded independently by two coders, then analyzed for themes informed by principles of constructivist grounded theory.ResultsSixty participants (33 males and 27 females) from 16 focus groups representing key stakeholder groups participated. Most recognized value in a national LEH that would facilitate a smooth learner transition from medical school to residency. Potential risks and benefits of the LEH were identified. Themes significant to the content, process and format of the LEH also emerged. Guiding principles of the LEH process were determined to include that it be learner-centered while supporting patient safety, resident wellness and professional behavior. The learner and representatives from their undergraduate medical education environment would each contribute to the LEH.ConclusionsThe LEH must advocate for the learner with respect for learner privacy, while promoting professionalism, patient safety and learner wellness.

Predictors of academic honesty and success in domestic and international occupational therapy students

PurposeAcademic integrity is the application of honest, ethical and responsible behaviours to all facets of students’ scholarly endeavours and is the moral code of academia. The international literature reports the prevalence of academic dishonesty in higher education across many disciplines (including the health sciences), and there is evidence linking academic dishonesty in health professional students with future unprofessional behaviour in the workplace. International students are reported to be a particularly vulnerable group. This paper aims to investigate the factors that may be predictive of academic honesty and performance in domestic and international occupational therapy students.Design/methodology/approachIn total, 701 participants (603 domestic students; 98 international students) were recruited from five Australian universities, and data were collected via a two-part self-report questionnaire. ANOVA and multi-linear regression analyses with bootstrapping were completed.FindingsTendency towards cheating and self-perception tendency towards dishonesty in research, gender, age and hours spent in indirect study were found to be statistically significant predictors of academic integrity and performance.Research limitations/implicationsLimitations of this study were the use of convenience sampling and self-report scales which can be prone to social desirability bias. Further studies are recommended to explore other potential predictors of academic honesty and performance in occupational therapy students.Originality/valueA range of predictors of academic honesty and success were found that will assist educators to target vulnerable domestic and international occupational therapy students as well as address deficiencies in academic integrity through proactive strategies.

Nursing profession and nurses' contribution to nursing education as seen through students' eyes: A qualitative study.

The behavior of clinical instructors, as observed by students, deeply influences their professional development. When instructors behave unprofessionally, they risk undermining the professional growth students gain from their clinical placement experience. Clinical instructors need to be aware of how their behavior can affect the students' learning process and the contributions they make to clinical nursing education. A qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using an inductive content analysis methodology. The nursing profession was described by the participants through five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas related to professionalism. Universities and schools of nursing should ascertain that clinical instructors are prepared to educate students. Faculty should clearly state to students what they can expect from the clinical experience, namely, preparing students to face real working environments that do not always reflect educational philosophies.

Influencing Factors of Social Media Marketing on Consumers Buying Decisions

In recent years, the world has witnessed a kind of social communication between humans in virtual cyberspace. The social networking is popular in marketing which utilizes the platform to present various marketing programs and strategies. The study based on the affecting influencing factors of social media marketing such as technology, infrastructure, culture, society in consumers’ buying decision in Saudi Arabia.The research focuses on consumer’s behavior and responses, in terms of indirect advertising, exaggerating on praising the product or service, false advertising, deceitful, and unprofessional behaviors. The research was carried out the buying behavior of customer through survey questionnaire. The results of the study concluded there is a relationship between Social media marketing on consumer purchasing decisions. The result further shows that e-advertising on the social media platforms has a negative impact on consumer purchasing behavior by stealth advertisement, unethical behavior, and fake advertise, and exaggeration on promoting a product to those who spend three hours or more on social networking sites in the Kingdom of Saudi Arabia.

The institutional impact after enacting student solutions to decrease barriers in reporting unprofessional behaviors.

This article was migrated. The article was marked as recommended. A two-year study was conducted to evaluate medical student perceptions on professionalism, including barriers to reporting misconduct and solutions to address barriers. Institutional changes occurred based on Year One findings: 1) a streamlined system (EthicsPoint®) was introduced to simplify the process of reporting and allow anonymous reports; 2) curriculum was revamped to include improved didactics on professionalism, instructions on using the EthicsPoint® system, and clerkship orientations that provided clear expectations of behavior by students, house-staff, and faculty; 3) semi-annually, students were asked to document witnessed misconduct, reassured that reports would be confidential, and reassured about protection from reprisal. In Year Two, we assessed changes in the culture of professionalism after institutional changes. Comparing Year Two to Year One, students demonstrated an increase in perceived confidence in ability to identify unprofessional behavior (p<0.01) and increased trust in protection from reprisal (p<0.01). In Year Two, students were more likely to report misconduct related to derogatory remarks about patients (p<0.01) and informed consent (p<0.01). By enhancing clarity about expectations for professional behavior, encouraging transparency through a streamlined and anonymous reporting process, and fostering trust that allows students to feel protected from reprisal, the culture of professionalism at an institution can be improved.