Development and Validation of a Simplified Chinese Version of the Assessment Tool for Students’ Perceptions of Medical Professionalism

Abstract

Professionalism is crucial in all professions and is particularly important in the medical field. Measuring students’ perceptions of professionalism can help to form education targeting the enhancement of professionalism. This study aimed to validate an effective assessment tool for the measurement of medical students’ perceptions of medical professionalism in mainland China. The cross-sectional survey was conducted in three medical colleges in Guangdong, China. Of the 2103 eligible medical students, 1976 responded, and 1856 questionnaires were deemed valid. Students from clinical medicine in these three medical colleges were randomly selected by cluster sampling. First, a Simplified Chinese Version questionnaire to measure Student’s Perception of Medical Professionalism (SCV-SPMP) was constructed. Second, questionnaires from 1856 students majoring in clinical medicine at three medical colleges were included in the analysis. Third, exploratory factor analysis, Cronbach’s alpha, item-subscale correlation, and confirmatory factor analysis were conducted to test the validity and reliability of the SCV-SPMP. Nine items were eliminated following exploratory factor analysis, and four subscales were extracted from the analysis. All internal consistency reliability exceeded the minimum standard. The overall Cronbach’s alpha was 0.94, and four subscales’ alphas were 0.82 (Accountability and excellence), 0.81 (Duty), 0.89 (Honor and integrity), and 0.85 (Practice habits and respect for others), respectively. The model fit was good. The convergent validity and discriminant validity were acceptable. The modified SCV-SPMP was found to be a valid and reliable tool to capture the main features of Chinese students’ perceptions of medical professionalism in four dimensions, and it provides a quantitative method for the measurement of the students’ perceptions in mainland China..

Keywords

medical professionalism / validation / assessment tool / medical student / perception

References

[1] KirchDG, GusicME, AstC. Undergraduate medical education and the foundation of physician professionalism. JAMA, 2015, 313(18): 1797-1798

[2] MarcovitchH. Governance and professionalism in medicine: a UK perspective. JAMA, 2015, 313(18): 1823-1824

[3] PapadakisMA, TeheraniA, BanachMA, et al.. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med, 2005, 353(25): 2673-2682

[4] SantenSA, PetrusaE, GruppenLD. The relationship between promotions committees’ identification of problem medical students and subsequent state medical board actions. Adv Health Sci Educ Theory Pract, 2015, 20(2): 421-430

[5] TeheraniA, HodgsonCS, BanachM, et al.. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Academic Medicine, 2015, 80: 17-20

[6] HouJ, MichaudC, LiZ, et al.. Transformation of the education of health professionals in China: progress and challenges. Lancet, 2014, 384(9945): 819-827

[7] BlackallGF, MelnickSA, ShoopGH, et al.. Professionalism in medical education: the development and validation of a survey instrument to assess attitudes toward professionalism. Medical Teacher, 2007, 29(2-3): e58-e62

[8] van MookWNKA, van LuijkSJ, O’SullivanH, et al.. The concepts of professionalism and professional behaviour: Conflicts in both definition and learning outcomes. Eur J Intern Med, 2009, 20(4): e85-e89

[9] CruessRL, CruessSR, JohnstonSE. Professionalism: an ideal to be sustained. Lancet, 2000, 356(9224): 156-159

[10] CruessSR, CruessRL. Expectations and Obligations: Professionalism and Medicine’s social contract with society. Perspect Biol Med, 2008, 51(4): 579-598

[11] HodgesBD, GinsburgS, CruessR, et al.. Assessment of professionalism: Recommendations from the Ottawa 2010 Conference. Med Teach, 2011, 33(5): 354-363

[12] ArnoldL. Assessing professional behavior: yesterday, today and tomorrow. Acad Med, 2002, 77(6): 502-515

[13] Project of the ABIM Foundation, ACP-ASIM Foundation,European Federation of Internal Medicine.. Medical professionalism in the new millennium: A Physician Charter. Ann Internal Med, 2002, 136(3): 243-246

[14] TsaiTC, LinCH, HarasymPH, et al.. Students’ perception on medical professionalism: the psychometric perspective. Med Teach, 2007, 29(2-3): 128-134

[15] Al-ErakyMM, ChandratilakeM, WajidG, et al.. Medical professionalism: development and validation of the Arabian LAMPS. Med Teach, 2003, 35: S56-S62

[16] KimS, ChoiS. The medical professionalism of Korean physicians: present and future. BMC Med Ethics, 2015, 16(1): 56

[17] LombartsKMJMH, PlochgT, ThompsonCA, et al.. Measuring professionalism in medicine and nursing: results of a European survey. PloS One, 2014, 9(5): e97069

[18] WangJ, HeB, MiaoX, et al.. The reliability and validity of a new professionalism assessment scale for young health care workers. Medicine, 2017, 96(25): e7058

[19] O’SullivanAJ, TooheySM. Assessment of professionalism in undergraduate medical students. Med Teach, 2008, 30(3): 280-286

[20] ChenJ, XuJ, ZhangC, et al.. Medical professionalism among clinical physicians in two tertiary hospitals, China. Soc Sci Med, 2013, 96: 290-296

[21] BowenLM, WilliamsB, StankeL. Professionalism among paramedic students: achieving the measure or missing the mark?. Adv Med Educ Pract, 2017, 8: 711-719

[22] KwonHJ, LeeYM, LeeYH, et al.. Development an instrument assessing residents’ attitude towards professionalism lapses in training. Korean J Med Educ, 2017, 29(2): 81-91

[23] LynchDC, SurdykPM, ArnoldR. Assessing professionalism: a review of the literature. Med Teach, 2004, 26(4): 366-373

[24] OjukaDK, OlenjaJM, Mwango’mbeNJ. Perception of medical professionalism among the surgical community in the University of Nairobi: a mixed method study. BMC Med Educ, 2016, 16(1): 101

[25] TsugawaY, TokudaY, OhbuS, et al.. Professionalism Mini-Evaluation Exercise for medical residents in Japan: a pilot study. Med Educ, 2009, 43(10): 968-978

[26] BaldwinDC, DaughertySR. David ThomasS. Using surveys to assess professionalism in individuals and institutions. Measuring medical professionalism, 2004, New York, Oxford University Press: 95

[27] van MookW v, LuijkSJ, O’SullivanH, et al.. General considerations regarding assessment of professional behaviour. Eur J Intern Med, 2009, 20(4): e90-e95

[28] HofstedeG. Culture’s Consequences: International differences in work-related values, 1980, Beverly Hills, SAGE Publications

[29] SchwartzSH. A theory of cultural values and some implications for work. App Psychol, 1999, 48(1): 23-47

[30] HoMJ, YuKH, PanH, et al.. A Tale of Two Cities: Understanding the differences in medical professionalism between two Chinese cultural contexts. Acad Med, 2014, 89(6): 944-950

[31] TangJ. Defending the dignity in the hustle and bustle: Review on The Eighth China-US Conference on Medical Professionalism. The Eighth China-US Conference on Medical Professionalism, 2013, Beijing, Peking University Health Science Center

[32] LeungDC, HsuEK, HuiEC. Perceptions of professional attributes in medicine: a qualitative study in Hong Kong. Hong Kong Med J, 2012, 18(14): 318-324

[33] PanH, NorrisJL, LiangYS, et al.. Building a professionalism framework for healthcare providers in China: A nominal group technique study. Med Teach, 2013, 35(10): e1531-e1536

[34] National college student information center.. Admission Scores of College Entrance Exam in previous years, 2018

[35] BonettDG. Sample size requirements for testing and estimating coefficient alpha. J Educ Behav Stat, 2002, 27(4): 335-340

[36] DeVellisRF. Guidelines in scale development, 1991

[37] HelmsJE, HenzeKT, SassTL. Treating Cronbach’s alpha reliability coefficients as data in counseling research. Counsel Psychol, 2006, 34(5): 630-660

[38] NunnallyJC. Introduction to psychological measurement, 1970, New York, McGraw-Hill

[39] LiuZ, YuanL, HuangY, et al.. Development of the Chinese version of the Hospital Autonomy Questionnaire: a cross-sectional study in Guangdong province. BMJ Open, 2016, 6(2): e10504

[40] ChenTF, ChouKR, LiaoYM, et al.. Construct validity and reliability of the Chinese version of the Disaster Preparedness Evaluation Tool in Taiwan. J Clin Nurs, 2015, 24(7-8): 1132-1143

[41] van der SchuwirthLW, VleutenCP. Challenges for educationalists. BMJ, 2006, 333(7567): 544-546

[42] BarberSL, YaoL. Development and status of health insurance systems in China. Intern J Health Plan Manage, 2011, 26(4): 339-356

[43] GinsburgS, RegehrG, HatalaR, et al.. Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med, 2000, 75(10): S6-S11

[44] JingS, JingM, HuG, et al.. Welfare, wellness, and job satisfaction of Chinese physicians: a national survey of public tertiary hospitals in China. Intern J Health Plan Manage, 2017, 32(3): 270-284

[45] YipW, HsiaoW. Harnessing the privatisation of China’s fragmented health-care delivery. Lancet, 2014, 384(9945): 805-818

[46] RaposoVL. Lost in ‘Culturation’: medical informed consent in China (from a Western perspective). Med Health Care Philos, 2019, 22(1): 17-30

[47] HuoJY. The Analects of Confucius. China Today, 2006, 89(12): 64-67

[48] McSweeneyB. Hofstede’s model of national cultural differences and their consequences: A triumph of faith -a failure of analysis. Human Relations, 2002, 55(1): 89-118

[49] YaoX. An Introduction to Confucianism, 2000, Cambridge, Cambridge University Press

[50] ZhangQ, LeeL, GruppenL, et al.. Medical education: changes and perspectives. Med Teach, 2013, 35(8): 621-627

[51] GoldieJ. Assessment of professionalism: A consolidation of current thinking. Med Teach, 2013, 35(2): e952-e956

[52] J Clin Diagn Res, 2016, 10(5):