Mohamed M. Al-Eraky

How medical professionalism is conceptualised in Arabian context: A validation study

Professionalism has been increasingly recognised as an explicit component of medical education, especially in the western world. Professionalism is culture-sensitive. Few efforts have been made to conceptualise professionalism in relation to the Arabian context. The aim of this study is to validate the components of professionalism framework of the American Board of Internal Medicine (ABIM) to the Arabian context. The authors invited a heterogeneous group of native Arab health professionals and academics to contribute to a reference panel. They represented a variety of disciplines, and seniority levels, and from different healthcare institutions and medical schools in Egypt, Saudi Arabia and United Arab Emirates. They were queried about their perception of the importance of each domain of professionalism as proposed by the ABIM, and were encouraged to suggest new domains if they thought it necessary. Thirty two out of the 45 invited health professionals and educators (71%) contributed to the reference panel. The panel confirmed the appropriateness of the six ABIM domains to the Arabian context, and further proposed the Autonomy of professionals as an additional domain. The modified framework, based on ABIM domains, demonstrated the Arabian conceptualisation of professionalism.

A Delphi study of medical professionalism in Arabian countries: The Four-Gates model

Abstract Background: Medical professionalism has been described as a set of attributes and behaviors, yet the Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries. Aim: This study aims to formulate a professionalism framework for healthcare providers as interpreted by local medical professionals in Arabian countries. Methods: A purposive sample of 17 experts from diverse disciplines participated in a Delphi study in three rounds. Consensus was identified by content analysis and by numerical analysis of responses on the basic attributes of medical professionalism in Arabian context. Results: Eight professional traits were shortlisted and coupled in four themes (Gates): dealing with self, dealing with tasks, dealing with others and dealing with God. Self-accountability and self-motivation were interpreted from a faithful viewpoint as “taqwa” and “ehtesab”, respectively, in Arabic. Discussion: The Four-Gates Model helps in better understanding of medical professionalism as grounded in the minds and culture of Arabs. The model may act as a genuine framework for teaching and learning of medical professionalism in Arab medical schools. Conclusion: The study highlights the divergent interpretation of medical professionalism between Western and Arabian contexts. The Four-Gates Model may work for faith-driven societies, but not for non-Muslims Arabs students or teachers or in institutions with humanistic values.

Medical professionalism: Development and validation of the Arabian LAMPS

Aim: This study aims to develop and validate a questionnaire that measures attitudes of medical students on professionalism in the Arabian context. Method: Thirty-two experts contributed to item generation in particular domains. The instrument was administered to Arab medical students and interns and responses were collected using five-point Likert scale. Data were analyzed to estimate the reliability of the instrument. The inventory in its final version was labeled as the Learners’ Attitude of Medical Professionalism Scale (LAMPS). Results: A total of 413 medical students and interns responded from two universities in Egypt and Saudi Arabia. Means of item response ranged from 2.38 to 4.72. The highest mainly deals with “Respect to others,” while the lowest belong to “Honor/Integrity.” The final version of the LAMPS has 28 items in five domains, with a reliability of 0.79. Discussion: The LAMPS has salient features compared to other similar instrument. It was designed based on a reliable framework in explicit behavioral items, not abstract attributes of professionalism. The LAMPS can help teachers to identify learning gaps regarding professionalism amongst their students and track attitude changes over time or as the result of interventions. Conclusion: To the best of our knowledge, the LAMPS is the first context-specific inventory on medical professionalism attitudes in the Arabian context.

Faculty development for learning and teaching of medical professionalism

Abstract Introduction: Professionalism must be explicitly taught, but teaching professionalism is challenging, because medical teachers are not prepared to teach this content area. Aim: This study aims at designing and evaluating a faculty development programme on learning and teaching professionalism in the Arabian context. Programme development: The study used a participatory design, where four authors and 28 teachers shared the responsibility in programme design in three steps: orientation workshop for teachers, vignette development, and teaching professionalism to students. The workshop provided the cognitive base on the salient attributes of professionalism in the Arabian context. After the workshop, authors helped teachers to develop a total of 32 vignettes in various clinical aspects, portraying a blend of professionalism dilemmas. A battery of seven questions/triggers was suggested to guide students’ reflection. Programme evaluation: The programme was evaluated with regard to its “construct” and its “outcomes”. The programme has fulfilled the guiding principles for its design and it has emerged from a genuine professionalism framework from local scholarly studies in the Arabian context. Programme outcomes were evaluated at the four levels of Kirkpatrick’s model; reaction, learning, behaviour, and results. Discussion: The study communicates a number of context-specific issues that should be considered when teaching professionalism in Arabian culture with respect to teachers and students. Three lessons were learned from developing vignettes, as reported by the authors. This study advocates the significance of transforming faculty development from the training discourse of stand-alone interventions to mentorship paradigm of the communities of learning. Conclusion: A three-step approach (orientation workshop, vignettes development, and teaching professionalism) proved effective for faculty development for learning and teaching of professionalism. Professionalism can be taught using vignettes that demonstrate professionalism dilemmas in a particular context.

The cultural flavours of problem-based learning

Editor – Frambach and her colleagues reported interesting findings about how students’ cultural backgrounds impact on problembased learning (PBL) in Hong Kong, the Middle East and the Netherlands. Although some readers will think it an over-simplification because culture is a complex dynamic issue that cannot be interpreted with one theory, it is interesting to consider these findings within the cultural domains identified by Hofstede. The results reported by Frambach et al. appear to resonate very well with this model, which suggests that it might be used to help further interpret their findings and build on their theoretical basis. Specifically, students’ readiness for PBL in Asian, Arab and Dutch contexts can be interpreted in view of three cultural indices studied by Hofstede.

Twelve Tips for teaching medical professionalism at all levels of medical education

Abstract Review of studies published in medical education journals over the last decade reveals that teaching medical professionalism is essential, yet challenging. According to a recent Best Evidence in Medical Education (BEME) guide, there is no consensus on a theoretical or practical model to integrate the teaching of professionalism into medical education. The aim of this article is to outline a practical manual for teaching professionalism at all levels of medical education. Drawing from research literature and author’s experience, Twelve Tips are listed and organised in four clusters with relevance to (1) the context, (2) the teachers, (3) the curriculum, and (4) the networking. With a better understanding of the guiding educational principles for teaching medical professionalism, medical educators will be able to teach one of the most challenging constructs in medical education.

Curriculum Navigator: aspiring towards a comprehensive package for curriculum planning.

Background: Insightful frameworks for curriculum development were described in the literature. There is a need, however, to outline the approach we prefer, sometime unconsciously, in curriculum planning. Aims: This article describes a novel conceptual framework called Curriculum Navigator, to explore our attitudes towards the current curriculum, focus of interest, perception of rules and resources, flexibility to reform, style of communication and pattern of decision-making in curriculum-related issues. Methods: The Curriculum Navigator integrates well-known approaches with 13 new ones into a comprehensive conceptual framework to explore the curriculum planning process and provides an original framework to plan and direct the route of curriculum development. This article provides a manual to use the inventory and further explains how to integrate Curriculum Navigator with other well-established frameworks to aspire towards a comprehensive package for curriculum development. Results: The Curriculum Navigator analyses our approach to curriculum planning and design in 10 dimensions. Each dimension is represented in a four-point continuum between two styles: lawyer/detective, birds eye/ants eye, non-human/human resources, bureaucratic/activist, dogmatic/fashionable, authoritative/collaborative decision-making, spy/salesman, magician/mentor, shopping/crafting and public relations/quality assurance. Conclusion: This article draws a visual portray of curriculum planning, design, management and reform in a particular school in one illustration.

Medical professionalism frameworks across non-Western cultures: A narrative overview

Abstract Background: Medical professionalism is context-specific, but most literature on professionalism stems from Western countries. This study is about benchmarking of different frameworks on professionalism and interpreting the commonalities and discrepancies of understanding professionalism across different cultures. We need to study the cultural underpinning of medical professionalism to graduate future “global” practitioners who are culturally sensitive enough to recognize differences (and also similarities) of expectations of patients in various contexts. Aim: This study aims at describing culture specific elements of three identified non-Western frameworks of professionalism, as well as their commonalities and differences. Method: A narrative overview was carried out of studies that address professionalism in non-Western cultures in the period 2002–2014. Results: Out of 143 articles on medical professionalism, only four studies provided three structured professionalism frameworks in non-Western contexts. Medical professionalism attributes in non-Western cultures were influenced by cultural values. Out of the 24 identified attributes of professionalism, 3 attributes were shared by the three cultures. Twelve attributes were shared by at least two cultures, and the rest of the attributes were unique to each culture. Conclusions: The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students’ and physicians’ professional identity formation.

A fresh look at Miller's pyramid: assessment at the ‘Is’ and ‘Do’ levels

In its silver jubilee, we celebrate the ground‐breaking pyramid of George Miller by submitting a fresh look at it. We discuss two questions. (i) Does the classical pyramidal structure perfectly portray the relationships of the four levels that were described by Miller? (ii) Can the model of Miller fulfill the unmet needs of assessors to measure evolving essential constructs and accommodate the increasingly sophisticated practice of assessment of health professionals? In response to the first question, Millers pyramid is revisited in view of two assumptions for pyramidal structures, namely: hierarchy and tapering. Then we suggest different configurations for the same classical four levels and indicate when to use each one. With regard to the second question, we provide a rationale for amending the pyramid with two further dimensions to assess personal qualities of students at the ‘Is’ level and their performance in teams at the ‘Do’ (together) level. At the end of the article, we yearn to think outside the pyramid and suggest the Assessment Orbits framework to assess students as individuals and in teams. The five Assessment Orbits alert educators to assess the emerging cognitive and non‐cognitive constructs, without implying features such as hierarchy or tapering that are ingrained in pyramidal structures. The ‘Is’ orbit attends to the personal qualities of graduates ‘who’ we may (or may not) trust to be our physicians. Assessment of teams at the ‘Do’ level (together) offers a paradigm shift in assessment from competitive ranking (storming) among students toward norming and performing as teams.

The effectiveness of sequencing virtual patients with lectures in a deductive or inductive learning approach

Abstract Background: Virtual patients (VPs) can be sequenced with other instructional methods in different ways. Aim: To investigate the effect of sequencing VPs with lectures in a deductive approach, in comparison with an inductive approach, on students’ knowledge acquisition, retention, and transfer. Methods: For two different topics, 84 out of 87 students have participated in the lecture and VP sessions. Students from female and male campuses have been randomly assigned to one of the two learning approaches (deductive and inductive), yielding four experimental groups. Each group received a lecture session and an independent VP learning activity, which either followed the lecture session in the deductive group or preceded it in the inductive group. Students were administrated knowledge acquisition and retention written tests as well as transfer tests using two new VPs. Results: There was no significant effect for the learning approach on knowledge acquisition or retention, while for knowledge transfer, males have benefited from the inductive approach in topic 1 while in the more complex topic 2, they have benefited from the deductive approach. On the other hand, females seem to be largely unaffected by learning approach. Conclusions: Sequencing VPs in inductive and deductive learning approaches leads to no significant differences on students’ performance when full guidance is offered in the inductive approach.