Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

Abstract

BackgroundAnecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.MethodsEight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.ResultsThe difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.ConclusionsThe findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.

Reflecting on BCMP students’ experiences of professionalism during clinical rotations

“…This entitlement to patient information is often associated with particular settings as similar findings were reported in Uganda and elsewhere in Africa. [20] Compassion and care BCMP students reflected on the value of demonstrating compassion and care in the clinical setting as an attribute mainly observed in Paeds similar to findings reported in two studies conducted in the USA. [11,12] The positive reflections that BCMP students experienced in Paeds were consistent with and met the recommendations of the HPCSA that require HCPs to always show regard for their patients as their primary professional duty.…”

“…The experiences of the students are supported by Tsotsi [19,20] who refers to the process of attaining informed consent in developing countries as a complex issue or a contentious issue that is context-specific. [20] Truth-telling BCMP students observed that for many of the adolescents, poor communication between HCPs and the patients was contrary to the best interests of the patients. The dilemma around the issue of trust that students faced was based on the fact that there was no consensus, e.g.…”

Religion and Medical Professionalism: Moving Beyond Social and Cultural Nuances

“…In Pakistan, Humayun et al 17 found that there was a striking lack of awareness of these principles, potentially due to the paternalistic model of patient care in many Asian cultures. Baingana and colleagues 18 reported that in Uganda, the community-centric Ubuntu philosophy ran contrary to the established Western notion of confidentiality. In Confucian-influenced societies, ideas are not considered to belong to the original author, but rather are part of society's collective knowledge, and reproducing ideas is perceived as being respectful to the owner rather than plagiarism.…”

Physicians' Practice of Dispensing Medicines

“…30 Dispensing is a task that physicians are expected to do but are not trained to do. The role of the hidden curriculum has been explored in the sphere of undergraduate medical education, 43 with areas such as professionalism 44,45 and ethics 46,47 receiving particular attention. The 100-year anniversary of the Flexner report into postgraduate medical education in the United States has recently transferred attention on the curriculum in this area, 48,49 with a refocusing on preparing physicians to work safely and effectively ahead of encyclopedic scientific knowledge.…”