Reflection on Professionalism: Retrospective Review of Health Professional Student Reflections


  • Betsabeh Parsa The University of British Columbia
  • Sue Murphy The University of British Columbia
  • Donna Drynan The University of British Columbia
  • Tal Jarus The University of British Columbia



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. 

Author Biographies

Betsabeh Parsa, The University of British Columbia

Betsabeh Parsa, B. Ed, M. Ed
Research Assistant,
Faculty of Medicine | Department of Physical Therapy
The University of British Columbia | Vancouver Campus

Sue Murphy, The University of British Columbia

Sue Murphy, B.H.Sc, M. Ed
Faculty of Medicine | Department of Physical Therapy
The University of British Columbia | Vancouver Campus

Donna Drynan, The University of British Columbia

Donna Drynan, M.Ed., OT(Reg)
Occupational Therapist
Associate Department Head & Academic Fieldwork Coordinator
Faculty of Medicine | Department of Occupational Science & Occupational Therapy

Tal Jarus, The University of British Columbia

Tal Jarus, PhD (OT), MA (OT), BOT, FCAOT
Faculty of Medicine | Department of Occupational Science & Occupational Therapy
The University of British Columbia | Vancouver Campus


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.

Aguilar, A. E., Stupans, L., & Scutter, S. (2011). Assessing students' professionalism: considering professionalism's diverging definitions. Education for health, 24(3), 599.

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.

American Physical Therapy Association. Professionalism in Physical Therapy: Core Values, 2009. Available at: . Accessed July 20, 2018.

Anderson, D. K., & Irwin, K. E. (2013). Self-assessment of professionalism in physical therapy education. Work, 44(3), 275–281.

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.

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.

Beauchamp, G. (2004). The challenge of teaching professionalism. Ann Acad Med Singapore, 33(6), 697–705.

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.

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.

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.

Brainard, A. H., & Brislen, H. C. (2007). Learning professionalism: a view from the trenches. Academic Medicine, 82(11), 1010–1014.

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.

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.

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.

Byszewski, A., Hendelman, W., McGuinty, C., & Moineau, G. (2012). Wanted: role models-medical students’ perceptions of professionalism. BMC medical education, 12(1), 115.

Canadian Association of Occupational Therapists. (2012). Profile of Occupational Therapy Practice in Canada. Retrieved from on September 09, 2019.

Charon, R. (2001). Narrative medicine: a model for empathy, reflection, profession, and trust. Jama, 286(15), 1897–1902.

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.

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.

Council of Canadian Physiotherapy University Programs (2019). National Physiotherapy Entry-to-Practice Curriculum Guidelines.

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.

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.

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.

Frank, J. R., Snell, L., & Sherbino, J. C. (2015). Physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada.

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.

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.

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.

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.

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.

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.

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.

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.

Irby, D. M., & Hamstra, S. J. (2016). Parting the clouds: three professionalism frameworks in medical education. Academic Medicine, 91(12), 1606–1611.

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.

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.

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.

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.

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.

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.

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.

Murphy, S., Whitehouse, L., & Parsa, B. (2018). Teaching professionalism: some features in Canadian physiotherapy programs. Physiotherapy theory and practice, 1–13.

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.

Passi, V., & Johnson, N. (2016). The impact of positive doctor role modeling. Medical teacher, 38(11), 1139–1145.

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.

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.

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.

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.

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.

Trumbo, S. P. (2017). Reflection fatigue among medical students. Academic Medicine, 92(4), 433–434.

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.

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.

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.

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.

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.

Wong, A., & Trollope‐Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education, 48(5), 489–501




How to Cite

Parsa, B., Murphy, S. ., Drynan, D. ., & Jarus, T. (2021). Reflection on Professionalism: Retrospective Review of Health Professional Student Reflections . International Journal of Practice-Based Learning in Health and Social Care, 9(1), 1–17.



Research Articles