Today's Medical students, Tomorrow’s professional Doctors; Formation of professionalism in medical students

Document Type : Original Article


1 PhD Student, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

2 Department of Educational Sciences, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran

3 Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Transition from student role to professional role It is an important step during the medical course. The discourses of professionalism education is ambiguous in different countries. The aimed of this study to explain the formation of professionalism in medical students.
Methods: The present study was a qualitative study using Jørgensen discourse analysis. Participants included 18 medical interns of Iranian universities of medical sciences. The average duration of each interview was 60 to 90 minutes. Data collection tools were in-depth semi-structured interviews and purposive sampling methods. Data collection continued until data saturation. The data analysis method was open coding.
Results: The mean age of study participants was 25.65± 9 9.12. The results include six concepts; Management of professional stress, professional competence, moral competence, human nature of profession, personal development, proper care and professional identity were the Nodal point in this discourse analysis; the curriculum is hidden.
Conclusions: If during the internship, certain professional beliefs and behaviors are not institutionalized in today's students, it can reduce the sensitivity of students' professionalism and makes professional decisions difficult for future physicians. Therefore, the role of formal education in professionalism is important in this regard, considering the role of the hidden curriculum.


  1. Harden RM. Curriculum planning and development. In: Dent JA, Harden RM, editors. A Practical Guide for Medical Teachers. 4th ed. London; New York: Elsevier, 2013.
  2. Yardley S, Kinston R, Lefroy J, Gay S, McKinley R. K. What do we do, doctor? Transitions of identity and responsibility: a narrative analysis. Adv Health Sci Educ. 2020; 1-19.
  3. Cuesta-Briand B, Auret K, Johnson P, Playford D. A world of difference’: a qualitative study of medical students’ views on professionalism and the ‘good BMC Med Educ. 2014; 14(1):77.
  4. Samuriwo R, Laws E, Webb K, Bullock A. I didn’t realize they had such a key role. Impact of medical education curriculum change on medical student interactions with nurses: a qualitative exploratory study of student perceptions. Adv Health Sci Educ. 2020; 25(1): 75-93.
  5. Foley NM, Maher BM, Corrigan MA. Social media and tomorrow’s medical students–how do they fit? J Surg Educ. 2014;71(3):385–90.
  6. Goss BD, Ryan AT, Waring J, Judd T, Chiavaroli NG, O’Brien RC, et al. The association between Situational Judgement Test (SJT) scores and professionalism concerns in undergraduate medical education. Med Teach. 2020; 42(8): 937-43.
  7. Lee H.J, Ahn M. Consensual qualitative research on the internship experience and development of career identity of Korean doctors. BMC Med Educ. 2021; 21(1): 1-8.
  8. Sullivan ME, Trial J, Baker C, Inaba K, Etcheverry J, Nally M. A framework for professionalism in surgery: what is important to medical students?. Am J Surg. 2014; 207(2): 255-9.
  9. Al-Eraky M. Twelve Tips For Teaching Medical professionalism At All Levels of Medical education. Med Teach. 2015; 37(11): 1018-25.
  10. Shooshtarizade SH, Yousefy A, Keshtiarai N. Is Professionalism Teachable in Medical Education? A Literature Review. Iranian Journal of Medical Education. 2018; 18: 269-81. Persian.
  11. Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med. 2013; 25(4): 369-73.
  12. Buyx AM, Maxwell B, Scho¨ne-Seifert B. Challenges of educating for medical professionalism: who should step up to the line?. Med Educ. 2008; 42(8): 758-64.
  13. Hawkins RE, Katsufrakis PJ, Holtman MC, Clauser BE. Assessment of medical professionalism: who, what, when, where, how, and..... why?. Med Teach. 2009; 31(4): 348-61.
  14. Gray K, Chang S, Kennedy G Use of social web technologies by international and domestic undergraduate students: implications for internationalizing learning and teaching in Australian universities. Tech Pedagog Educ. 2010; 19(1):31–4.
  15. Wald HS. Professional identity (trans) formation in medical education: reflection, relationship, resilience. Acad Med. 2015; 90(6):701–6.
  16. Cohen, J. Professionalism in medical education, an American perspective: from evidence to accountability. Med Educ. 2006; 40: 607-17.
  17. Passi V, Johnson S, Peile E, Wright S, Hafferty F, Johnson N. Doctor role modelling in medical education: BEME Guide No. 27. Med Teach. 2013; 35(9):e1422-e36.
  18. Harden RM. Curriculum planning and development. In: Dent JA, Harden RM, editors. A Practical Guide for Medical Teachers. 4th ed. London; New York: Elsevier, 2013.
  19. Duke LJ, Kennedy WK, McDuffie CH, Miller MS, Sheffield MC, Chisholm MA. Student attitudes, values, and beliefs regarding professionalism. Am J Pharm Educ. 2005;69(5):104.
  20. Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, et al. Professionalism in Medicine: Results of National Survey of Physicians. Ann Intern Med. 2007; 147(11): 795-802.
  21. Bryan RE, Krych AJ, Carmichael SW, Viggiano TR, Pawlina W. Assessing Professionalism In Early Medical Education: Experience With Peer Evaluation And Self-Evaluation In The Gross Anatomy Course. Ann Acad Med Singap. 2005; 34(8):486-91.
  22. Cottrell S, Diaz S, Cather A, Shumway J. Assessing Medical Students Professionalism: An Analysis of a Peer Assessment. Med Educ Online. 2006; 11(1): 4587.
  23. Jørgensen M, Phillips L. Discourse Analysis as Theory and Method. SAGE Publications Ltd 6 Bonhill Street London EC2A 4PU. First published. 2002.
  24. Kim C.H, Kim J.Y. The effect of clinical practice belonging, satisfaction with major, and work values on career identity of nursing students. The Journal of Korean Academic Society of Nursing Education. 2020; 26(3): 259-68.
  25. Irby DM, Hamstra SJ. Parting the clouds: three professionalism frameworks in medical education. Acad 2016; 91(12):1606–11.
  26. Wynia MK, Papadakis MA, Sullivan WM, Hafferty FW. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Acad Med. 2014; 89(5): 712–14.
  27. Green M, Zick A, Makoul G. 2009. Defining professionalism from the perspective of patients, physicians, and nurses. Acad Med 84:566–573.
  28. Bahazic W, Crosby E. Physician professional behavior affects outcomes: a framework for teaching professionalism during anesthesia residency. Can J Anesth; 2011:58:1039–50.
  29. Mueller PS, Snyder L. Dealing with the “disruptive” physician colleague. Copyright 2009. Available at: Accessed February 2, 2015.
  30. Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. Med Teach. 2013; 35(7):e1252-e66.
  31. Weissmann PF, Branch WT, Gracey CF, et al. Role modeling humanistic behavior: learning bedside manner from the experts. Acad Med. 2006; 81(7):661–67.
  32. American Board of Internal Medicine (ABIM). Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136(3): 243-46.
  33. Stegers-Jager KM, Cohen-Schotanus J, Themmen AP. Motivation, learning strategies, participation and medical school performance. Med Educ 2012; 46(7):678-88.
  34. Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012; 34(9): e641-8.
  35. Hur Y. Are There Gaps between Medical Students and Professors in the Perception of Students’ Professionalism Level? Yonsei Med J 2009; 50(6):751-56.
  36. Kinghorn WA. Medical education as moral formation: An Aristotelian account of medical Perspect Biol Med. 2010; 53(1): 87-105.
  37. Leo T  Eagen Professionalism Education: The Medical Student Response. Perspect Biol Med. 2008; 51(4): 508-16.
  38. Eckert T, Topping, D, Abrams M, Daly K. Beyond academic learning: how can human cadaver dissection promote medical students’ professional identity development?. The FASEB Journal. 2020; 34(S1): 1-1.