Original Article

Personal factors affecting medical professionalism: a qualitative study in Iran


Professional behavior with patients and interactions with colleagues, the institution and professional bodies are influenced by many factors. The purpose of this manuscript is to clarify those personal factors affecting medical professionalism in clinical settings affiliated with Tehran University of Medical Sciences.
For this purpose, a qualitative study was carried out. One hundred and eighty-two participants were recruited through purposive sampling of clinical staff, physicians, and medical students in Tehran. Data were collected through 22 focus group discussions, and conventional content analysis was used to analyze the data. 
The results were reported in five categories to present the participants’ views. Categories were extracted from 103 codes and consisted of 1) people's belief in professionalism, 2) personality traits, 3) problems in family, 4) mental or physical health status, and 5) communication skills.
The results showed that despite the facilitator roles of some personal factors, others act as barriers to professional behaviors. In order to control their impact, it is crucial to pay attention to them at the time of student/staff selection. Strengthening support systems in the organization is also essential for decreasing the effect of family problems or physical and mental health problems.

London RCoPo, editor Doctors in Society: Medical Professionalism in a Changing World: Technical Supplement to a Report of a Working. UK: Royal College of Physicians of London; 2005.

Cohen JJ. Professionalism in medical education, an American perspective: from evidence to accountability. Medical education. 2006; 40(7): 607-17.

Lesser CS, Lucey CR, Egener B, Braddock CH, Linas SL, Levinson W. A behavioral and systems view of professionalism. JAMA. 2010; 304(24): 2732-7.

Levinson W, Ginsburg S, Hafferty F, Lucey CR. Understanding Medical Professionalism. USA: McGraw Hill Professional; 2014.

Ratanawongsa N, Bolen S, Howell EE, Kern DE, Sisson SD, Larriviere D. Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements. Journal of General Internal Medicine. 2006; 21(7): 758-63.

Anonymous. Task force on professionalism, barriers to professionalism. WMJ. 2003; 102(2): 8-9.

Kwakman K. Factors affecting teachers’ participation in professional learning activities. Teaching and Teacher Education. 2003;19(2):149-70.

Eesteghamati A, Bardaran H, Monajemi A, Khankeh HR, Geranmayeh M. Core components of clinical education: a qualitative study with attending physicians and their residents. Journal of Advances in Medical Education & Professionalism. 2016; 4(2): 64-71.

McManus I, Keeling A, Paice E. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve-year longitudinal study of UK medical graduates. BMC Medicine. 2004; 2: 29.

West CP, Shanafelt TD. The influence of personal and environmental factors on professionalism in medical education. BMC Medical Education. 2007; 7(1): 29.

Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002 ; 287(2) : 226-35.

Saeedi Tehrani S, Nayeri F, Jafarian A, et al. Development of the first guideline for professional conduct in medical practice in Iran. Arch Iran Med. 2017; 20(1): 12:0-0

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15(9):1277-88.

Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: a focus on trustworthiness. SAGE Open. 2014; 4(1): 1-10.

Jensen NM, Suchman AL. Partnering with citizens to reform Wisconsin health care: A report of the first Citizen Congress II. WMJ: Official Publication of the State Medical Society of Wisconsin. 2004;105(3):41-4.

Dehghani A, Dastpak M, Gharib A. Barriers to respect professional ethics standards in clinical care; viewpoints of nurses. Iranian Journal of Medical Education. 2013; 13(5): 421-430.

Mosalanezhad L, Tafvizi M, Dezhkam L, Porkhorshid M. Barriers to Compliance with the Codes of Medical Ethics at Hospitals Affiliated with Jahrom University of Medical Sciences in 2016. Pakistan Journal of Medical and Health Sciences. 2017; 11(4): 1629-36.

Mahfoozpour S, Mojdekar R. Attitudes of health care providers toward teamwork, safety climate and knowledge. Advances in Nursing & Midwifery. 2012; 22(76).

Behnia O, HosseinPour M, Zare K. The analysis of the team working facilitating factors among nurses working in training centers affiliated with the University of Jondi SHapour in Ahvaz. Avicenna J Nurs Midwifery care. 2016; 24(4): 247-55.

Kalantari R, Zakerian SA, Mahmodi Majdabadi M, Zanjirani Farahani A, Meshkati M, Garosi E. Assessing the teamwork among surgical teams of hospitals affiliated to social security organizations in Tehran city. JHOSP. 2016; 15(3): 21-29.

Shu LL, Mazar N, Gino F, Ariely D, Bazerman MH. Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end. PNAS. 2012;109(38):15197-200.

Shalvi S, Gino F, Barkan R, Ayal S. Self-serving justifications: doing wrong and feeling moral. Current Directions in Psychological Science. 2015; 24(2): 125-30.

Doherty EM, Nugent E. Personality factors and medical training: a review of the literature. Medical Education. 2011; 45(2): 132-40.

Eckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching “Generation Y”. Journal of Graduate Medical Education. 2011; 3(4): 458-61.

Byszewski A, Hendelman W, McGuinty C, Moineau G. Wanted: role models-medical students’ perceptions of professionalism. BMC medical education. 2012; 12:115.

Epstein M, Howes P. The millennial generation: recruiting, retaining, and managing. Today’s CPA. 2006;10.

DiLullo C, McGee P, Kriebel RM. Demystifying the millennial student: a reassessment in measures of character and engagement in professional education. Anatomical Sciences Education. 2011; 4(4): 214-26.

Kanter MH, Nguyen M, Klau MH, Spiegel NH, Ambrosini VL. What does professionalism mean to the physician? Perm J. 2013; 17(3): 94.

Khosrojerdi Z, Tagharrobi Z, Sooki Z, Sharifi K. Predictors of happiness among Iranian nurses. International Journal of Nursing Sciences. 2018; 5(3): 281-6.

Post SG. Altruism, happiness, and health: It’s good to be good. International Journal of Behavioral Medicine. 2005; 12(2): 66-77.

Ghamari Zare z, Alizadeh Barmi Z, Sadat Sadegholvaad H, Esmaeili M, Romouzi M. Study of barriers professional ethics in the practice of nurse care from nurse managers’ viewpoints in year 2013. Education & Ethics in Nursing. 2014; 3(1): 57-63.

Lie D, Carter-Pokras O, Braun B, Coleman C. What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy. Journal of Health Communication. 2012; 17(suppl. 3): 13-22.

Arnold EC, Boggs KU. Interpersonal Relationships E-Book: Professional Communication Skills for Nurses, 7th ed. USA: Saunders; 2015.

Kadivar M, Mosayebi Z, Asghari F, Zarrini P. Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience. J Med Ethics Hist Med. 2015; 8.

Schluter J, Winch S, Holzhauser K, Henderson A. Nurses' moral sensitivity and hospital ethical climate: a literature review. Nurs Ethics. 2008; 15(3): 304-21.

Borhani F, Abbazzadeh A, Mohsenpour M. Barrier to acquiring ethical sensitivity: perceptions of nursing students. Medical Ethics Journal. 2016; 5(15): 83-104.

Weaver K, Morse J, Mitcham C. Ethical sensitivity in professional practice: concept analysis. Journal of advanced nursing. Journal of Advanced Nursing. 2008; 62(5): 607-18.

Sprangers S, Dijkstra K, Romijn-Luijten A. Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides. Clinical Interventions in Aging. 2015; 10: 311-9.

IssueVol 13 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jmehm.v13i3.2842
Medical professionalism: Clinical setting; Qualitative research; Professional behavior; Personal factors

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Alipour F, Shahvari Z, Asghari F, Samadi S, Amini H. Personal factors affecting medical professionalism: a qualitative study in Iran. J Med Ethics Hist Med. 2020;13.