Developing and validating an instrument to measure: the medical professionalism climate in clinical settings
This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach’s alpha and ICC.
At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of “personal behavior”, “collegiality” and “respect for patient autonomy” in a 25-item questionnaire for service providers and a single factor of “professional behavior” in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers’ questionnaire and the single factor explained 63.9% of the variance for patients’ questionnaire.
The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.
Pereira I, Cunningham AM, Moreau K, Sherbino J, Jalali A. Thou shalt not tweet unprofessionally: an appreciative inquiry into the professional use of social media. Postgrad Med J. 2015; 91(1080): 561-4.
Anonymous. Advancing education in medical professionalism. [cited on October 2021]; https://webcampus.med.drexel.edu/professionalism/ACGME-Professionalism.pdf
Anonymous. Doctors in Society: Medical Professionalism in a Changing World: Technical Supplement to a Report of a Working Party. UK: Royal College of Physicians of London; December, 2005.
Swick HM, Szenas P, Danoff D, Whitcomb ME. Teaching professionalism in undergraduate medical education. JAMA. 1999; 282(9): 830-2.
Saeedi Tehrani S, Nayeri F, Jafarian A, et al. Development of the first guideline for professional conduct in medical practice in Iran. Arch Iran Mede. 2017; 20(1): 12-15.
Irby DM, Hamstra SJ. Parting the clouds: three professionalism frameworks in medical education. Acad Med. 2016; 91(12): 1606-11.
Karnieli-Miller O, Vu TR, Frankel RM, et al. Which experiences in the hidden curriculum teach students about professionalism? Acad Med. 2011; 86(3): 369-77.
Gofton W, Regehr G. What we don't know we are teaching: unveiling the hidden curriculum. Clin Orthop Relat Res. 2006; 449: 20-7.
Bell SK, Wideroff M, Gaufberg L. Student voices in readers’ theater: exploring communication in the hidden curriculum. Patient Educ Couns. 2010; 80(3): 354-7.
Kalet A, Buckvar-Keltz L, Monson V, et al. Professional identity formation in medical school: one measure reflects changes during pre-clerkship training. MedEdPublish. 2018; 21;1.
Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012; 34(9): e641-8.
Thrush CR, Spollen JJ, Tariq SG, Williams DK, Ii JMS. Evidence for validity of a survey to measure the learning environment for professionalism. Med Teach. 2011; 33(12): e683-8.
Levinson W, Ginsburg S, Hafferty F, Lucey CR. Understanding Medical Professionalism,1st ed. USA: McGraw Hill Education / Medical; 2014.
Al Gahtani HMS, Jahrami HA, Silverman HJ. Perceptions of medical students towards the practice of professionalism at the Arabian Gulf University. BMC Medical Education. 2021; 21: 38.
Olson LL. Hospital nurses' perceptions of the ethical climate of their work setting. Image J Nurs Sch. 1998; 30(4): 345-9.
Farley MJ, Nyberg J. Environment as a major element in nursing administration practice theory development. Nurs Health Care. 1990; 11(10): 532-5.
Suhonen R, Berg A, Idvall E, et al. Adapting the individualized care scale for cross‐cultural comparison. Scand J Caring Sci. 2010; 24(2): 392-403.
Petroz U, Kennedy D, Webster F, Nowak A. Patients' perceptions of individualized care: evaluating psychometric properties and results of the individualized care scale. Can J Nurs Res. 2011; 43(2): 80-100.
Pronovost PJ, Weast B, Holzmueller CG, et al. Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Qual Saf Health Care. 2003; 12(6): 405-10.
Quaintance JL, Arnold L, Thompson GS. Development of an instrument to measure the climate of professionalism in a clinical teaching environment. Acad Med. 2008; 83(10 Suppl.): S5-8.
Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio revisiting the original methods of calculation. Measurement and Evaluation in Counseling and Development. 2014; 47(1): 79-86.
Courtney MGR, Gordon M. Determining the number of factors to retain in EFA: using the SPSS R-Menu v2.0 to make more judicious estimations. Practical Assessment, Research and Evaluation. 2013;18(8): 1-14.
Yong AG, Pearce S. A beginner’s guide to factor analysis: focusing on exploratory factor analysis. Tutorials in Quantitative Methods for Psychology. 2013; 9: 79-94.
Kellar SP, Kelvin EA. Munro's Statistical Methods for Health Care Research, 6th ed. USA: Lippincott Williams & Wilkins; 2012.
Rummel J. Applied Factor Analysis. USA: Northwestern Universtiy Press; 1988.
Bujang MA, Omar ED, Baharum NA. A review on sample size determination for Cronbach’s alpha test: a simple guide for researchers. Malays J Med Sci. 2018; 25(6): 85-99.
Cullen JB, Victor B, Bronson JW. The ethical climate questionnaire: an assessment of its development and validity. Psychological Reports. 1993; 73(2): 667-74.
Wangsaturak D, McAleer S. Development of the clinical learning climate measure for undergraduate medical education. South East Asian J Med Educ. 2008; 2: 2.
Nowrouzi-Kia B, Fox MT. Factors associated with intent to leave in registered nurses working in acute care hospitals: a cross-sectional study in Ontario, Canada. Workplace Health Saf. 2020 ;68(3): 121-8.
Hossny EK, Sabra HE. Effect of nurses’ perception to workplace civility climate on nurse–physician collaboration. Nursing Open. 2021; 8(2): 620-7.
Korthagen FAJ. In search of the essence of a good teacher: towards a more holistic approach in teacher education. Teaching and Teacher Education. 2004; 20(1): 77-97.
Hodges BD, Ginsburg S, Cruess R, et al. Assessment of professionalism: recommendations from the Ottawa 2010 conference. Med Tea. 2011; 33(5): 354-63.
Liang Y, Noble LM. Chinese doctors’ views on workplace-based assessment: trainee and supervisor perspectives of the mini-CEX. Med Educ Online. 2021; 26(1): 1869393.
Jha V, Mclean M, Gibbs TJ, Sandars J. Medical professionalism across cultures: a challenge for medicine and medical education. Med Teach. 2015; 37(1): 74-80.
|Issue||Vol 14 (2021)|
|Professionalism Clinical setting Questionnaire Validation|
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