Medical professionalism is a group of attitudes and behaviors of the physician which causes him to prioritize his patients' advantages over his. Professionalism can be studied from two points of views :from the point of professional advantages and the point of responsibilities and tasks(1).A real professional have to be qualified with all supposed criteria in his field such as doing the job with a high quality in different fields (such as field of creativity ,production ,human services ,and basic and advanced researches) and also should have high standards of professionalism codes and loyalty t them while doing the job .A professional does a special task for the society which is not expected from other members of that society and in exchange gets specific points as well which the society does not give to other professions (for example being qualified enough to know the confidential points of patients' lives and etc.)(2-4).
In 2002 American Board of Internal Medicine (ABIM),with the American College of Physicians and American Society of Internal Medicine (ACP-ASIM) and European Federation of Internal Medicine (EFIM) wrote medical professionalism pyramid according to three basic principles which were the advantage of the patient and caring about the patient's values ,respecting the patient's independence and not taking his right to make decisions, and improvement of social justice especially in treatment-health fields which was assigned by hundreds of physicians and medical organizations all over the world(6-4).These three principles can be put in to practice by professionals' being loyal to the ten orders below.
1.Having the essential qualifications for medical work and maintaining, improving, and updating these qualifications,2.honesty,3.keeping secrets, 4.making appropriate relationship with the patients,5.developing and improving the quality of the given services,6.improving the society's accessibility to medical care and helping develop publicizing health care services,7.fair distribution of limited health care resources,8.attracting and maintaining the society's trust to oneself and the whole profession by continuous and proper management of interest conflict, 9.having scientific knowledge and commitment to learning and progressive education,10.being professionally responsible.(2,8-6)
Evidence shows that professionalism is becoming less important and new physicians are facing cases and problems which threaten values.(9) Also a review of medical journals and diversity of articles and studies in the case of professionalism expresses that medical education experts have paid a lot of attention to this matter in recent years and are trying to overcome the threats.
According to the novelty of this topic in medical education of our country,
And especially as no study has been done in this case among residents in Guilan University of Medical Sciences we decided to study the attitudes of the residents of this university toward medical professionalism and their behavior.
This descriptive sectional study was done in Guilan University of Medical Sciences in the educational year of 1390-91.
In the first step ,the researchers designed a questionnaire by using articles and questionnaires which were used for studying professionalism in other countries(10,11) which was adjusted according to the basics of professionalism ,the purpose of the study ,and ethical-cultural issues of our country.
The questionnaire included two parts of attitude with 24 questions ,and behavior 14 questions .The answers to the questions were qualitative ,which varied from none to very much in the first part and in the second part answers were decided appropriately with the questions.
The mentioned questionnaire was given to a number of experts of Guilan University of Medical Sciences for determining its reliability .In the next step its validity was determined by Pilot test on 15 people and its Alpha Cronbach was 0.854.According to the limited number of residents of medical school of Guilan University of Medical Sciences sampling was not done and census was used.
The questionnaire was distributed among 189 residents of 214 fields and all years .The researchers returned among participants for three times for collecting the answers with the interval of 1-2 weeks .The residents' participation was optional and they were free not to mention their name or field of specialty.
Data was analyzed by T-student Test and Stata software.
Out of 189 residents who had received the questionnaire , 140 filled the in and participated in the study. The average age was 32.2+ _ 4.49,the youngest person was 26 and the oldest one was 46.63 people (45%) were male and 59 (42.1%) were female and in 18 answer sheets gender was not mentioned .All were graduated from General Physician period in average 6.5+_ 4.18 years ago. In average 29.3% of the participants were studying in the first year,27.90% in the second year,25.70% in the third ,and 13.6% in the fourth year of residency.
The importance of each one of variables of professionalism principles from the viewpoint of residents is shown in table no.1.
The residents' attitude toward achieving the most reliable information and applying it in their daily routine and knowing evidence-based medicine (p=0.005),caring about the control of smoking (p=0.023) and caring about drug abuse by youngsters (p=0.005) based on gender ,respecting social justice (p=0.028);caring about nutrition and obesity (p=0.036)and caring about air pollution (p=0.039)based on field and considering the patient as a human and avoiding calling him with medical disorders instead of his name based on gender and year of residency (p=0.043,0.021 respectively) were meaningfully different.
Female residents in comparison to males believed more in evidence-based medicine, also respecting social justice in major specialties(internal, general surgery, gynecology, and pediatric)was more than minor fields. Females and residents of third and fourth years considered patients as a human more than males and residents of first and second year .In major specialties such as internal and gynecology ,residents cared more about nutrition and obesity. Female residents cared more than males .Female residents cared more about the control of smoking than males and the residents of major fields cared about pollution more than other fields.
The frequency of performance of professional behaviors based on residents' answers are shown in table no.2.
The number of weekly studied articles ,based on field (p=0.035),the record of having made medical mistakes without doing anything after (such as reporting it )based on gender (p=0.032) and participation in doing social services ;city/regional ,in the past few years ,based on gender and age (p=0.04,p=0.035) were meaningfully different .In a way that the residents of major fields read more articles than residents of other majors in week. Not reporting big medical mistakes were more common among males than females and males and residents of 30-34 cooperated more in doing social services in the past year.
In the present study the attitudes of residents of Guilan University of Medical Sciences toward medical professionalism and professional behavior were examined. Moreover ,a need survey was also done alongside.
The study of the frequency the importance level of the written questions in the attitude part expressed that more than 80% and even more than 90% of the residents had paid average or a lot of attention to cases such as tendency to spend the courses and Recertification Tests, not considering gender and racial differences in the health care of patients ,taking the essential medical care of the patients without considering their financial status ,knowing the methods of Life Long Learning and updating their knowledge, getting the most reliable information and applying it their daily job ,knowing Evidence –based Medicine ,being socially responsible and believing in social justice,
Being aware of the history of one's profession and specialty ,having updated technical skills ,adaptability and adjustability, being pleased with being supervised ,the ability to manage the contrastive advantages, interaction with the members of the health care team, interaction and knowing the principles of group work, and considering the patient as a human being and avoiding calling him with medical technical terms of disorder instead of his name.76% of the residents paid average or a lot of attention for reporting the medical mistakes and reporting about unqualified colleagues has been popular among 53% of them.
Less than 6% of the residents had paid little attention to nutrition and obesity ,education ,control of smoking and drug abuse specially among youngsters, wearing a seat belt ,pollution, and supporting medical insurances for the people not having them .All of the cared a lot about vaccination.
Less than 50% of the residents had sent Emails to patients, used online medical education methods and computer software for medical decision making, and participated in social services of the city , area, or country.70% of the residents read one to four articles a week. More than 50% had used online journals, could evaluate the new clinical science, had used other physicians' notes in order to improve the quality of their function in the past three years and apply the principles of medical professionalism while practicing medicine and doing other responsibilities as much as possible.11% of the residents had changed their clinical decision during their professional life because of getting a reward from commercial departments.
A study has been conducted by Joyner (2007) in Washington University in the case of if defining and teaching professionalism to residents and faculties can improve professional behaviors. According to the results of this study training interns and residents had a considerable effect on the improvement of their professional behaviors. (12)
In the comparison of the attitudes of the residents of first and second year with the residents of third and fourth year toward various principles of medical professionalism ,the only difference in their attitudes has been considering the patient as a human being and avoiding calling him by medical terms, the results showed that the residents of third and fourth year paid more attention to this matter .Although these groups had not taken up the educational course before residency which expresses that the residents'' professional perfection, spending more time with patients and role-model instructors can be the cause of this difference.
In the present study besides studying the attitudes and behaviors of the residents in professionalism ,a king of need survey was also done and strong and weak points of the residents were determined to a great extent .By having such data a better professionalism curriculum can be planned in which the strong points of the future specialists can become stronger and the weak points can become strong while their beliefs and insight perfection are also being respected.
The residents had a very positive attitude toward the principles of professionalism but did not apply it in their behavior to this extent and professionalism curriculum should be planned in a way to change the strong points to stronger and weak points to strong.
The authors would like to express their gratitude to Research in Education Unit of the Education Development Center of the Medical School and the Education Development Center of the Education Deputy of Guilan University of Medical Sciences which supported us in conducting this study.
This study was conducted by the financial support of the Research Deputy of Guilan University of Medical Sciences.
Conflict of Interests
This study does not include the official codes of interest conflicts.
This study has been confirmed by the Research Committee of Guilan University of Medical Sciences