Reflection on Professionalism: Retrospective Review of Health Professional Student Reflections
Keywords:occupational therapy, physical therapy, professionalism, students’ reflection
Professionalism is one of the core competencies for occupational and physical therapists. However, difficulty in providing clear definitions of core professional values and behaviours makes professionalism a complex concept to teach. Most proposed frameworks for defining the concept are theoretical or have focused on the academics’ and clinicians’ perspectives; evidence from students’ experiences is lacking. The purpose of this study was to develop a framework to define the concept of professionalism from occupational therapy (OT) and physical therapy (PT) students’ perspectives through analysis of their reflections. The study was a retrospective content analysis of OT and PT students’ reflections completed during clinical placements from 2014-2015 academic years. Sixty students (30 PT and 30 OT) were randomly sampled and one anonymized reflection of each of these students was selected. The qualitative content analysis was initiated by applying a deductive approach using previously presented frameworks to define professionalism. Four themes emerged which resulted in a new framework to define professionalism from students’ perspectives. The emergent themes included the effect of context, the relational dimension, personal dimension, and societal dimension. Students considered context an overarching factor influencing all dimensions of professionalism. Although their perceptions of professionalism were comparable to other presented frameworks, they primarily focused on the relational and personal dimensions of professionalism. The results of this study indicate that OT and PT students consider professionalism as a multi-dimensional and context-specific concept. Despite understanding contextual barriers, at this stage of their professional identity development, students tried to adhere to ethics, and professional values and responsibilities.
Adam, K., Gibson, E., Strong, J., & Lyle, A. (2011). Knowledge, skills and professional behaviours needed for occupational therapists and physiotherapists new to work-related practice. Work, 38(4), 309 –318. https://doi.org/10.3233/WOR-2011-1134
Aguilar, A. E., Stupans, L., & Scutter, S. (2011). Assessing students' professionalism: considering professionalism's diverging definitions. Education for health, 24(3), 599. https://www.educationforhealth.net/text.asp?2011/24/3/599/101417
Aguilar, A., Stupans, I., Scutter, S., & King, S. (2012). Exploring professionalism: The professional values of Australian occupational therapists. Australian Occupational Therapy Journal, 59(3), 209–217. https://doi.org/10.1111/j.1440-1630.2012.00996.x
American Physical Therapy Association. Professionalism in Physical Therapy: Core Values, 2009. Available at: http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Judicial_Legal/ProfessionalismCoreValues.pdf . Accessed July 20, 2018.
Anderson, D. K., & Irwin, K. E. (2013). Self-assessment of professionalism in physical therapy education. Work, 44(3), 275–281. https://doi.org/10.3233/WOR-121504
Arntfield, S. L., Slesar, K., Dickson, J., & Charon, R. (2013). Narrative medicine as a means of training medical students toward residency competencies. Patient education and counseling, 91(3), 280–286. https://doi.org/10.1016/j.pec.2013.01.014
Aston, S. J., Rheault, W., Arenson, C., Tappert, S. K., Stoecker, J., Orzoff, J., Galitski, H., & Mackintosh, S. (2012). Interprofessional education: a review and analysis of programs from three academic health centers. Academic Medicine, 87(7), 949–955. https://doi.org/10.1097/ACM.0b013e3182583374
Beauchamp, G. (2004). The challenge of teaching professionalism. Ann Acad Med Singapore, 33(6), 697–705. https://www.annals.edu.sg/pdf200412/Gallie.pdf
Bernard, A. W., Malone, M., Kman, N. E., Caterino, J. M., & Khandelwal, S. (2011). Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation. BMC emergency medicine, 11(1), 11. https://doi.org/10.1186/1471-227X-11-11
Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T., & Nass, D. (2013). Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. Medical teacher, 35(7), e1252–e1266. https://doi.org/10.3109/0142159X.2013.789132
Bossers, A., Kernaghan, J., Hodgins, L., Merla, L., O'Connor, C., & Van Kessel, M. (1999). Defining and developing professionalism. Canadian Journal of Occupational Therapy, 66(3), 116–121. https://doi.org/10.1177/000841749906600303
Brainard, A. H., & Brislen, H. C. (2007). Learning professionalism: a view from the trenches. Academic Medicine, 82(11), 1010–1014. https://doi.org/10.1097/01.ACM.0000285343.95826.94
Bulk, L. Y., Drynan, D., Murphy, S., Gerber, P., Bezati, R., Trivett, S., & Jarus, T. (2019). Patient perspectives: Four pillars of professionalism. Patient Experience Journal, 6(3), 74–81. https://doi.org/10.35680/2372-0247.1386
Burford, B., Morrow, G., Rothwell, C., Carter, M., & Illing, J. (2014). Professionalism education should reflect reality: findings from three health professions. Medical education, 48(4), 361–374. https://doi.org/10.1111/medu.12368
Boyczuk, A. M., Deloyer, J. J., Ferrigan, K. F., Muncaster, K. M., Dal Bello-Haas, V., & Miller, P. A. (2019). Professional Values: Results of a Scoping Review and Preliminary Canadian Survey. Physiotherapy Canada, 71(2), 134–143. https://doi.org/10.3138/ptc.2017-70.e
Byszewski, A., Hendelman, W., McGuinty, C., & Moineau, G. (2012). Wanted: role models-medical students’ perceptions of professionalism. BMC medical education, 12(1), 115. https://doi.org/10.1186/1472-6920-12-115
Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from https://www.caot.ca/document/3653/2012otprofile.pdf on September 09, 2019.
Charon, R. (2001). Narrative medicine: a model for empathy, reflection, profession, and trust. Jama, 286(15), 1897–1902. https://doi.org/10.1001/jama.286.15.1897
Chen, I., & Forbes, C. (2014). Reflective writing and its impact on empathy in medical education: Systematic review. Journal of Educational Evaluation for Health Professions, 11, 20. https://doi.org/10.3352/jeehp.2014.11.20
Constantinou, M., & Kuys, S. S. (2013). Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: A qualitative study. Physiotherapy, 99(1), 49–55. https://doi.org/10.1016/j.physio.2011.12.002
Council of Canadian Physiotherapy University Programs (2019). National Physiotherapy Entry-to-Practice Curriculum Guidelines. https://peac-aepc.ca/pdfs/Resources/Competency%20Profiles/CCPUP%20Curriculum%20Guidelines%202019.pdf
Cruess, R. L., Cruess, S. R., & Steinert, Y. (Eds.) (2016). Teaching medical professionalism: Supporting the development of a professional identity. Cambridge University Press.
Cruess, S. R., & Cruess, R. L. (1997). Professionalism must be taught. BMJ: British Medical Journal, 315(7123), 1674. https://doi.org/10.1136/bmj.315.7123.1674
Dutton, L. L., & Sellheim, D. O. (2017). Academic and clinical dissonance in physical therapist education: how do students cope? Journal of Physical Therapy Education, 31(1), 61–72. https://doi.org/10.1097/00001416-201731010-00009
Durocher, E., Kinsella, E. A., McCorquodale, L., & Phelan, S. (2016). Ethical tensions related to systemic constraints: Occupational alienation in occupational therapy practice. OTJR: occupation, participation and health, 36(4), 216–226. https://doi.org/10.1177/1539449216665117
Frank, J. R., Snell, L., & Sherbino, J. C. (2015). Physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada. https://www.royalcollege.ca/rcsite/documents/canmeds/canmeds-full-framework-e.pdf
Furze, J. A., Greenfield, B. H., Barr, J. B., Geist, K., Gale, J., & Jensen, G. M. (2018). Clinical narratives in residency education: Exploration of the learning process. Physiotherapy theory and practice, 1–16. https://doi.org/10.1080/09593985.2018.1472686
Gaufberg, E. H., Batalden, M., Sands, R., & Bell, S. K. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine, 85(11), 1709–1716. https://doi.org/10.1097/ACM.0b013e3181f57899
Geddes, E. L., Wessel, J., & Williams, R. M. (2004). Ethical issues identified by physical therapy students during clinical placements. Physiotherapy Theory and Practice, 20(1), 17–-29. https://doi.org/10.1080/09593980490425076
Greenfield, B., Bridges, P., Phillips, T., Adams, E., Bullock, D., Davis, K., Nelson, C., & Wood, B. (2015). Reflective narratives by physical therapist students on their early clinical experiences: A deductive and inductive approach. Journal of Physical Therapy Education, 29(2), 21–31.
Hafferty, F. W. (1998). Beyond curriculum reform: confronting medicine's hidden curriculum. Academic medicine: journal of the Association of American Medical Colleges, 73(4), 403–407. https://doi.org/10.1097/00001888-199804000-00013
Hodges, B. D., Ginsburg, S., Cruess, R., Cruess, S., Delport, R., Hafferty, F., Ho, M-J., Holmboe, E., Holtman, M., Ohbu, S., Rees, C., ten Cate, O., Tsugawa, Y., van Mook, W., Wass, V., Wilkinson, T., and Wade, W., (2011). Assessment of professionalism: recommendations from the Ottawa 2010 Conference. Medical teacher, 33(5), 354–363. https://doi.org/10.3109/0142159X.2011.577300
Hodges, B., Paul, R., Ginsburg, S., & the Ottawa Consensus Group Members. (2019). Assessment of professionalism: From where have we come–to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism. Medical teacher, 41(3), 249–255. https://doi.org/10.1080/0142159X.2018.1543862
Hudon, A., Drolet, M. J., & Williams-Jones, B. (2015). Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review. Physiotherapy Canada, 67(2), 124–132. https://doi.org/10.3138/ptc.2014-10
Hudon, A., Laliberté, M., Hunt, M., Sonier, V., Williams-Jones, B., Mazer, B., Badro, V., & Ehrmann Feldman, D. (2014). What place for ethics? An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada. Disability and rehabilitation, 36(9), 775–780. https://doi.org/10.3109/09638288.2013.813082
Irby, D. M., & Hamstra, S. J. (2016). Parting the clouds: three professionalism frameworks in medical education. Academic Medicine, 91(12), 1606–1611. https://doi.org/10.1097/acm.0000000000001190
Karnieli-Miller, O., Vu, T. R., Holtman, M. C., Clyman, S. G., & Inui, T. S. (2010). Medical students' professionalism narratives: A window on the informal and hidden curriculum. Academic Medicine: Journal of the Association of American Medical Colleges, 85(1), 124–133. https://doi.org/10.1097/acm.0b013e3181c42896
Kenny, N. P., Mann, K. V., & MacLeod, H. (2003). Role modeling in physicians’ professional formation: Reconsidering an essential but untapped educational strategy. Academic Medicine, 78(12), 1203–1210. https://doi.org/10.1097/00001888-200312000-00002
Kinsella, E. A., Park, A. J. S., Appiagyei, J., Chang, E., & Chow, D. (2008). Through the eyes of students: Ethical tensions in occupational therapy practice. Canadian Journal of Occupational Therapy, 75(3), 176–183. https://doi.org/10.1177/000841740807500309
Leedham-Green, K. E., Knight, A., & Iedema, R. (2019). Intra-and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences. BMC medical education, 19(1), 287. https://doi.org/10.1186/s12909-019-1722-8
Levett-Jones, T. L. (2007). Facilitating reflective practice and self-assessment of competence through the use of narratives. Nurse education in practice, 7(2), 112–119. https://doi.org/10.1016/j.nepr.2006.10.002
Monrouxe, L. V., Rees, C. E., & Hu, W. (2011). Differences in medical students’ explicit discourses of professionalism: acting, representing, becoming. Medical education, 45(6), 585–602. https://doi.org/10.1111/j.1365-2923.2010.03878.x
Mulder, H., ter Braak, E., Chen, H. C., & ten Cate, O. (2018). Addressing the hidden curriculum in the clinical workplace: a practical tool for trainees and faculty. Medical teacher, 1–8. https://doi.org/10.1080/0142159x.2018.1436760
Murphy, S., Whitehouse, L., & Parsa, B. (2018). Teaching professionalism: some features in Canadian physiotherapy programs. Physiotherapy theory and practice, 1–13. https://doi.org/10.1080/09593985.2018.1491080
National Physiotherapy Advisory Group, (2017). Competency Profile for Physiotherapists in Canada.
O’Donnell, J. F. (2014). Introduction: The hidden curriculum—a focus on learning and closing the gap. In: Hafferty, F. W. & O’Donnell, J.F. (Eds.), The hidden curriculum in health professional (p. 1–20). Dartmouth College Press.
O'Sullivan, A. J., Howe, A. C., Miles, S., Harris, P., Hughes, C. S., Jones, P., Scicluna, H., & Leinster, S., (2012). Does a summative portfolio foster the development of capabilities such as reflective practice and understanding ethics? An evaluation from two medical schools. Medical Teacher, 34(1), e21–e28. https://doi.org/10.3109/0142159x.2012.638009
Passi, V., & Johnson, N. (2016). The impact of positive doctor role modeling. Medical teacher, 38(11), 1139–1145. https://doi.org/10.3109/0142159X.2016.1170780
Rees, C. E., Monrouxe, L. V., & McDonald, L. A. (2013). Narrative, emotion and action: analysing ‘most memorable ’professionalism dilemmas. Medical Education, 47(1), 80–96. https://doi.org/10.1111/j.1365-2923.2012.04302.x
Rogers, D. A., Boehler, M. L., Roberts, N. K., & Johnson, V. (2012). Using the hidden curriculum to teach professionalism during the surgery clerkship. Journal of Surgical Education, 69(3), 423–427. https://doi.org/10.1016/j.jsurg.2011.09.008
Robinson, A. J., Tanchuk, C. J., & Sullivan, T. M. (2012). Professionalism and occupational therapy: An exploration of faculty and students’ perspectives. Canadian Journal of Occupational Therapy, 79, 275–284. http://doi.org/10.2182/cjot.2012.79.5.3
Rutberg & Gaufberg, (2014). Medical student narratives and the hidden curriculum. The hidden curriculum in health professional education, 106–116.
Sandars, J. (2009). The use of reflection in medical education: AMEE Guide No. 44. Medical teacher, 31(8), 685-695. https://doi.org/10.1080/01421590903050374
Sullivan, T. M., & Thiessen, A. K. (2015). Occupational therapy students’ perspectives of professionalism: An exploratory study. The Open Journal of Occupational Therapy, 3(4), 9. https://doi.org/10.15453/2168-6408.1154
Trumbo, S. P. (2017). Reflection fatigue among medical students. Academic Medicine, 92(4), 433–434. https://doi.org/10.1097/acm.0000000000001609
Van De Camp, K., Vernooij-Dassen, M. J., Grol, R. P., & Bottema, B. J. (2004). How to conceptualize professionalism: a qualitative study. Medical teacher, 26(8), 696–702. https://doi.org/10.1080/01421590400019518
Wald, H. S., & Reis, S. P. (2010). Beyond the margins: Reflective writing and development of reflective capacity in medical education. Journal of General Internal Medicine, 25(7), 746–749. https://dx.doi.org/10.1007%2Fs11606-010-1347-4
Wald, H. S., White, J., Reis, S. P., Esquibel, A. Y., & Anthony, D. (2018). Grappling with complexity: Medical students’ reflective writings about challenging patient encounters as a window into professional identity formation. Medical Teacher, 1–9. https://doi.org/10.1080/0142159x.2018.1475727
Wessel, J., & Larin, H. (2006). Change in reflections of physiotherapy students over time in clinical placements. Learning in Health and social care, 5(3), 119–132. https://doi.org/10.1111/j.1473-6861.2006.00124.x
Williams, R. M., Wessel, J., Gemus, M., & Foster-Seargeant, E. (2002). Journal writing to promote reflection by physical therapy students during clinical placements. Physiotherapy Theory and Practice, 18(1), 5–15. https://doi.org/10.1080/095939802753570657
Wong, A., & Trollope‐Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education, 48(5), 489–501 https://doi.org/10.1111/medu.12382
How to Cite
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons License "Attribution-NonCommercial No Derivs 4.0 International" (CC BY-NC-ND 4.0) which permits others to use the publication as long as the authors are appropriately cited.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The Author grants to Coventry University an irrevocable, royalty-free, worldwide, non-exclusive licence to publish this article in this journal in addition to the licence granted at paragraph 1 of this copyright notice.