The mismatch between teaching and assessing professionalism: a practice architecture analysis of three professional programmes

ABSTRACT

While there is broad agreement about their importance, courses in professionalism have proven difficult to teach and assess. Furthermore, there is currently a lack of knowledge regarding problems that are common across professional boundaries. The purpose of this article is to examine what teaching and assessing professionalism in higher education entails in three distinctly different professional education contexts in Sweden: medical, police, and social-work education. The study is qualitative and comparative, with data consisting of documents (curricula, syllabi, course content n > 200), interviews (n = 18), and participant observations (∼30 h) of how professionalism is taught and assessed in each programme. The results describe the practice architectures of teaching and assessing professionalism, where problems and dilemmas are made visible. The results also show a tension between the ambition to practise and the ambition to assess, which leads to what we call ‘assessment avoidance’.

KEYWORDS:

• Professionalism
• professional education
• practice theory
• medical education
• social work education
• police education

Introduction

Course content aimed at developing students’ professionalism is a common feature of undergraduate professional education leading to human services professions. Professions such as police officers, doctors, and social workers regularly interact with citizens experiencing hardship, often at the most vulnerable points in their lives. These professionals must be able to act and solve problems in challenging situations (Fenwick 2016; Holm 2002). They must also be able to handle a high emotional load and make quick, sometimes life-changing decisions (Christersson et al. 2008; Heder 2009). Furthermore, professionals are expected to exercise discretion and act responsibly in adverse and complex situations. Given these characteristics of professional practice, it is crucial for educators to prepare future professionals for a practice that requires agency, empathy, respectful behaviour, and reflexivity.

In this article, we examine what teaching and assessing professionalism in undergraduate programmes entails through the lens of practice architectures (Kemmis et al. 2014; Kemmis and Grootenboer 2008). Using this approach, we aim to contribute to the scholarly discussion about how practices can be structured to support students' development of professionalism. While there is broad agreement about its importance, professionalism has proven difficult to teach and assess. Professionalism is based on practice-oriented and tacit knowledge (Bradbury et al. 2015), which differs from the forms of knowledge with which higher education teachers traditionally work. Professionalism as a subject matter is often contested and associated with problems such as a lack of consensus and ambiguities (O'Sullivan et al. 2012). According to Dall'Alba (2023) and Fawns et al. (2021), curriculum development is needed to prepare students for the situated and complex practices of professional life. Studies have also shown that students have difficulty understanding the purpose and meaning of professionalism and tend to downplay the importance of such content as irrelevant, as opposed to subject-specific content (Leo and Eagen 2008; Neve, Lloyd, and Collett 2017; Wilson et al. 2013). Professionalism is also difficult to evaluate because traditional forms of assessment mainly focus on knowledge and understanding, while professionalism to a larger extent is based on the enactment of professional norms. As a result, research has shown that educators find themselves in complex situations when it comes to assessing students’ knowledge and skills relating to professionalism (Bryden et al. 2010).

Adding to the complexity is the fact that professionalism is often domain and profession-specific, and thus isolated within each professional arena. This ‘siloing’ of knowledge has led to a situation where little knowledge is shared between different professions. As stated by Bradbury et al. (2015), because professional education is often tied to specific professions, there is currently a lack of knowledge about common denominators or problems in the teaching and assessment of professionalism that span professional boundaries.

Thus, there is a need to study issues relating to professionalism across professional fields to promote a wider dialogue about how professionalism can be taught and assessed. In this article, we facilitate such a discussion as we examine how teachers teach and assess professionalism in medical, police, and social-work programmes. To do so, we use the theoretical framework of practice architectures (TPA, Kemmis and Grootenboer 2008). TPA enables a fine-grained analysis of educational practices that support the development of professionalism and directs attention towards arrangements that enable and constrain the practices and hold them in place (Kemmis et al. 2014).

Using TPA as its theoretical and analytical framework, the purpose of this article is to examine what teaching and assessing professionalism in higher education entails in three different educational programmes: police, medical, and social-work education. Specifically, we aim to identify common practices of teaching and assessing professionalism that cut across the different professions. We also analyse how various arrangements impact the practices of professionalism courses.

Professionalism as an elusive concept

Despite our direct involvement in various practices, they often remain invisible and implicit, a phenomenon that also applies to education, particularly in the teaching and assessment of professionalism (Aspfors 2012). The term ‘professionalism’ is elusive, making these educational practices especially challenging to deconstruct, verbalise, and clarify.

Professionalism is broadly and widely accepted as a set of qualities or characteristics associated with a professional individual or worker. Key characteristics include expertise, dedication, ethics, and a commitment to continuous learning and improvement (Abbott 1988; Eraut 1994; Evetts 2011). However, the concrete conceptualisation of professionalism varies significantly. It is understood differently in previous research and across different professional practices. As Nerland (2018, 242) stated, ‘Traditional forms of professionalism are being challenged as relations between professions, their clients, governments, and other stakeholders are changing’. Consequently, there is no consensus on what professionalism means and what the objectives of course content aimed at developing students’ professionalism should be (Birden et al. 2014).

Content aimed at developing students’ professionalism is found under various designations in professional education programmes in higher education. Often, this content is directed towards learning professional norms and is usually interspersed with subject-specific course content (Barbara-i-Molinero, Cascon-Pereira, and Hernandez-Lara 2017; Wilson et al. 2013). The fundamental idea in professional education is that students learn a knowledge base (‘body of knowledge’) through subject-specific courses and acquire practices belonging to their respective professional discipline through professional development (Reid et al. 2008).

According to Langelotz (2014, 46), teachers representing a profession ‘become not only discourse bearers but also discourse and practice architects […] teachers contribute to (discursive) constructions about and in different educational practices’. The goal of professionalism education is for students to understand norms regarding decision-making, responsibility, ethics, and professional competence through reflection, work-based education, and interaction with role models (Wilson et al. 2013).

Studies on professionalism are usually conducted in relation to specific professional fields, meaning that professionalism education is described differently within different professions. ‘Classical’ professions often focus on providing students with experiences of specific professional situations and role models, while ‘newer’ professions may require more exploration of future professional identity (Reid et al. 2008) and the development of professional norms (Chinaris 2012).

Research has found that students within different professional educational contexts perceive professionalism education as problematic. For example, in medical education, studies show that students often deprioritize professionalism content because they perceive it as ‘fuzzy’ and unclear (Leo and Eagen 2008). Studies in other empirical contexts have shown that teaching aimed at developing professionalism is perceived as abstract and irrelevant (Fulchand, Kilgour, and Anstey 2014; Neve, Lloyd, and Collett 2017).

In contrast to studies on student perspectives, research on professional higher education has focused on how professional norms in different disciplinary fields can be translated into educational and learning outcomes (Michelsen et al. 2017). A risk in professionalism education is that students, due to their position, may not fully understand professional knowledge and behaviours, leading to imitation and superficial displays of ‘symbolic’ behaviour (Wilson et al. 2013).

According to students, many forms of assessments lack the situational aspects of performance valued in professional practice, favouring abstract, procedural, or objective aspects instead (Fawns et al. 2021). Viewing professionalism education as preparation for professional work also raises assessment challenges for teachers, who must evaluate students’ professional knowledge before they enter professional life. These courses serve a central gatekeeping function, as teachers are expected to identify inappropriate behaviours (e.g. Chinaris 2012).

Furthermore, professionalism education has a socialising and normative function because it focuses on the development of norms and behaviours within different professional practices (Wilson et al. 2013). With these premises, professionalism education is often based on practice-oriented knowledge, which differs from the forms of knowledge with which higher education teachers traditionally work. For instance, Rantatalo and Lindberg (2018) showed that complex questions regarding professionalism are often addressed in liminal spaces rather than in traditional teaching settings such as classrooms.

In summary, course content aimed at developing students’ professionalism highlights the importance of critical sensitivity in assessments. However, the orientation and placement of the content before entering professional life present difficulties in assessing ‘good’ and ‘less good’ professional behaviour by the student. How this balance is negotiated in educational practices is of central importance in this study.

The theory of practice architectures

To address the problems described above and to start unpacking what teaching and assessing professionalism entails, we use the theory of practice architectures (TPA) originally developed by Kemmis and Grootenboer (2008). The theory illuminates the field of education and provides a contemporary description of social reality that focuses on what happens in an educational practice (Rönnerman 2018). TPA is a resource for understanding and revealing how the studied educational practices are enabled and constrained ‘by the conditions under which they occur’ (Mahon et al. 2017, 2). In this article, we use TPA as both a theoretical and analytical resource. It helps us to understand the teaching and assessment of professionalism through a lens of practice.

Practice has been defined in different ways, with many references to a ‘temporally evolving, open-ended set of doings and sayings’ (Schatzki 2002, 87). Based on Schatzki’s (2002) definition, above, Kemmis and Grootenboer (2008) adds ‘relatings’ and refers to practice as a form of human action in history where actions (doings) are understood in terms of ideas and talk (sayings), and those involved are in different types of relationships (relatings) to each other. A practice is composed of sayings, doings and relatings, hanging together in the project of the practice. The project reflects the aim or the intention of the specific practice, and all the interconnected sayings, doings and relatings carried out in the practice (Kemmis et al. 2014; Kemmis and Edward-Groves 2018; Kemmis and Grootenboer 2008).

Practice architectures are ‘combinations of cultural-discursive, material-economic and social-political arrangements that enable and constrain how a practice can unfold’ (Kemmis 2019, 13). These external structures are present in or brought to a site and exist in three dimensions parallel to the sayings, doings and relatings. The arrangements prefigure, shape and are shaped by the practice and keep the practice in place (Kemmis et al. 2014; Kemmis and Grootenboer 2008).

Cultural-discursive arrangements appear in a dimension of semantic space mediated through language, material-economic arrangements appear in a dimension of physical space mediated through activity and work, and social-political arrangements appear in a dimension of social space mediated through power and solidarity (Kemmis et al. 2014; Kemmis and Grootenboer 2008).

To make sense of the teaching and assessing of professionalism from a TPA perspective, we have operationalised the theory in the following way in relation to our empirical object of study: The development of professionalism can be understood as a central project. Teaching and assessment are conceptualised as closely related, but analytically separate practices that both relate to the project of developing professionalism. In the dimension of semantic space, ideas and specialist discourses of professionalism associated with medical, social work or police education (cultural-discursive arrangement) shape how teachers talk(sayings) about teaching and assessing professionalism, and what they discuss during activities with students. In the dimension of physical space–time, the resources for organisation and physical set-ups (material-economic arrangements) shape different type of learning activities and actions of teachers and students(doings) in these activities. Finally, in the dimension of social space the roles and power (social-political arrangements) of teachers simultaneously teaching and making assessments, and students giving each other feedback shape the relationships (relatings) between teachers and students, and among students themselves.

Methods

This study is based on a multi-method design in which we employ document analysis, interviews, and participant observations.

Sampling

We conducted a theoretical sampling to analyse professionalism content in medical, social-work, and police education across three Swedish programmes. This sampling aimed to explore both similarities and differences in these university-affiliated professional programmes, all of which lead to professions or semi-professions centred around human services. Despite their shared focus on professionalism in situations involving individuals, patients, or clients in vulnerable positions, these programmes diverge in historical roots, economic aspects, and jurisdictional boundaries.

The medical programme spans 5.5 years, with significant clinical exposure starting in the fourth year. Professionalism content, totalling 0.5 years, is distributed across smaller units taught each semester. In contrast, the social-work programme lasts 3.5 years, consolidating clinical training into a single course during the fifth semester. Professionalism is seamlessly woven into courses throughout the programme. The police education programme, lasting 2.5 years, explicitly addresses professionalism in a concentrated 5-week course that emphasises reflection on the police role. However, other courses include numerous training sessions touching upon professionalism-related issues, including the specific scenario we observed (see below).

Data collection

Data collection occurred in three steps. Initially, the first author of the paper gathered and reviewed 1070 pages of documents acquired through the learning platforms of the programmes. The documents, including syllabi, study guides, and lecture plans, comprehensively covered the programmes’ design of teaching and assessment. This initial analysis primarily offered context and an overview of the educational programmes, aiding in the selection of themes for subsequent analysis and in the identification of suitable participants for interviews.

In the second phase of data collection, semi-structured interviews were carried out with teachers responsible for teaching professionalism. Participation was voluntary, and prior written consent was obtained. A total of 18 semi-structured interviews were conducted with teachers (ten women; eight men) – seven from the police programme, five from the social-work programme, and six from the medical programme. The first author conducted 16 interviews, while the second and third authors conducted one each. The interviews delved into teachers’ perspectives on professionalism, as well as their approaches to teaching and assessing professionalism within the respective programmes. An interview guide was formulated, centred around ‘sensitising concepts’ (cf. Bowen 2006), such as professionalism teaching, the assessment of professionalism, and relationships with students. The interviews, lasting between 60–120 min, were conducted and recorded via Zoom and subsequently transcribed verbatim.

In the third stage of data collection, we conducted participant observations on 11 occasions. These observations targeted three training sessions (one from each educational context) where the teaching and assessment of professionalism occurred. Prior to each observation, we visited students to inform them about the research, and written or verbal consent was obtained individually from the research participants. The first author observed each session, sometimes accompanied by one or two additional observers (the authors of the article). Following the approach outlined by Jeffrey and Troman (2004), our method of participant observations can be termed ‘selective intermittent,’ involving time-compressed observation of specifically relevant events rather than continuous presence over an extended period. For this study, we opted to observe sessions with similar content and objectives in the three programmes, aiming to comprehend the teaching practice in its real context. The chosen training sessions shared common learning objectives, focusing on ‘difficult conversations’.

In the context of police education, the first and second authors observed a training session wherein police students in their fourth semester conveyed a death notice to a family member of a deceased individual. The learning objective of the session was focused on how to behave professionally in a difficult and emotional situation. The students, working in uniform in pairs, assumed the roles of police officers in a roleplay scenario against hired actors within a training facility set up like a real apartment. The session was observed by 4–5 student observers with a teacher present. Subsequently, the teacher facilitated a feedback session/discussion involving all the participating roles (students acting as police officers, actors, observers).

In the social work training sessions, all authors observed social work students in their fourth semester, the semester preceding clinical training, leading counselling sessions. The learning objective focused on how to professionally handle emotions when interacting with clients expressing strong feelings. The students took on the role of social workers in roleplays, with classmates portraying clients in small rooms. Each session was scripted with various emotional challenges (e.g. dealing with anger, sorrow, disappointment). The sessions were observed by 1–2 students, with a teacher briefly present (or, in some cases, no teacher presence). Following the roleplay, the students engaged in an unstructured round of feedback, allowing all participants to reflect on the scenario. The teacher provided feedback and posed reflective questions when involved.

In medical education, the first, second, and fourth authors observed a session wherein medical students in their ninth semester trained on decision-making in challenging patient meetings. The students assumed the roles of doctors in a roleplay scenario involving hired actors, conducted in a standard small classroom. The session was observed by 8–9 students with a teacher present. Following the session, the students facilitated a structured round of feedback, where students, hired actors, and teachers engaged in discussions about the cases. The complete dataset for this study is summarised in Table 1.

Table 1. Data for the study.

	Documents	Interviews	Participant observations
Medical ed	434 pages Syllabus, study guides, lecture plans, schedules (first author)	6 teacher interviews (first author)	‘Consultation’: Training session where medical students are exposed to decision-making during difficult patient meetings. No of sessions: 5 Total: 47 h Observers: 3 (first, second and fourth author)
Social Work ed	407 pages Syllabus, study guides, lecture plans, schedules (first author)	5 teacher interviews (first author)	‘Dealing with affect’: Training session where social-work students lead social-work counselling sessions and are exposed to strong emotional outbursts from clients. No of sessions: 4 Total: 12 h Observers: 3 (first third and fourth author)
Police ed	229 pages Syllabus, study guides, lecture plans, schedules (first author)	7 teacher interviews (first author)	‘Bereavement and loss’: Training session in which police students give a death notice to a bereaved family member and are exposed to strong emotional reactions. No of sessions: 4 Total: 8 h Observers: 2 (first and second author)

With this design, the primary responsibility for data collection rested with the first author, while the other researchers participated in selected parts based on their expertise. Having more than one observer present at sessions allowed for continuous discussion and validation of interpretations throughout the data collection process.

Analysis

The analysis of all types of data was carried out concurrently with data collection, following an iterative abductive approach (Srivastava and Hopwood 2009). This entailed simultaneous engagement in data collection, theoretical reading, and analysis, with each component reinforcing the others. The first author took the main responsibility for the analytical steps, while discussions regarding findings, interpretations, and theorisation occurred among all authors throughout the process.

Initially, the first author analysed documents with a focus on content. The objective was to obtain an overview of how professionalism courses were structured, the central themes guiding the course content, and the setup of assessment. Documents were meticulously read and coded based on educational context, intended learning outcomes, teaching and learning activities, assessment, and feedback. As mentioned, this initial step of the analysis established a framework for the subsequent data collection.

Following the initial analysis, interviews and observations were categorised into two overarching groups based on our research questions: teaching and assessment. The objective was to identify commonalities across cases regarding teaching and assessment. In pursuit of this goal, the analysis was informed by the theoretical concepts from TPA. Specifically, we examined the practices of teaching and assessing professionalism using the concepts of central sayings, doings, and relatings. Additionally, we scrutinised the practice architectures by analysing constraining and enabling arrangements pertaining to activities within the practices. This stage of the analysis aimed to achieve a deeper, theoretically informed understanding of the cross-case, central findings from the empirical material.

The analysis was executed using NVivo 12, where we constructed thematic data structures in accordance with these steps. In the findings section, these data structures have been translated into two tables summarising the main findings. Throughout the analysis phase, we carried out participant validation by presenting provisional findings and analytical insights at four meetings (each lasting two hours) with a mixed group of teacher representatives from the participating programmes. Some members of this group were also interviewees, while others participated as disciplinary experts. The first of these meetings introduced our approach and data collection, a second meeting occurred after the initial analysis of documents, a third meeting took place during the analysis of interviews and observations, and the final meeting occurred after finalising the analysis.

Findings

In the following, we present the results of the analysis guided by TPA. Tables 2 and 3 provide an overview of the results, divided into practice (sayings, doings, relatings) and the practice architectures (cultural-discursive, material-economic, and social-political arrangements) that we argue underpin these practices. This division within and between practices and architectures is made for analytical purposes.

Table 2. How is professionalism taught on these educational programmes?

Practice	Practice architectures
Sayings	Cultural-discursive arrangements
The subject core (empathy, interpersonal relations, self-awareness) Student activity Situational flexibility Importance of trust and benevolence	Lack of (verbalised) consensus about the subject core The idea of exposure The idea of imitating realism The idea of complexity (difficult, surprising, confusing)
Doings (implementation)	Material-economic arrangements
Reflection/discussion Scenario training Acting in realistic scenarios	Equipment Training facilities Teacher time and resources Hired actors
Relatings	Social-political arrangements
Student-centred Level of trust between students	Teacher authority (teacher to students) Deviation from higher education teaching traditions

Table 3. How is professionalism assessed?

Practice	Practice architectures
Sayings	Cultural-discursive arrangements
Assessment is detrimental to learning Exposure to uncertainty and stressful situations ‘Rites of passage’	Fairness Objectivity Professional requirements (this is what you will have to handle in the future)
Doings	Material-economic arrangements
Assessment of reflection (oral and written) Administration of active attendance Ambiguity in instructions (is this an assessment or not?)	Teacher time Resources
Relatings	Social-political arrangements
Power asymmetry between teacher and student Student group dynamics	Exercising public authority (teacher) Institutional rules for assessment

Teaching professionalism

The practice of teaching professionalism using the theoretical concepts of TPA is described in Table 2.

Table 2. The teaching of professionalism in all three educational contexts was characterised by a number of sayings regarding the subject core of professionalism, student activities, situational flexibility, and the importance of trust. We constructed these aspects as central sayings based on the teachers’ expressed views and instructions and syllabi describing their respective teaching practices.

The subject core of professionalism was defined with keywords such as empathy, interpersonal relations, and self-awareness, which, in our interpretation, also characterised the core content of the teaching. Secondly, teachers emphasised the importance of student activity, where students should act, reflect, and discuss. Thirdly, according to teachers in all three educational contexts, a central idea was that professionalism entails the application of professional knowledge in various situations. Many learning activities were thus designed to test the students’ judgement and situational flexibility to apply knowledge correctly. Fourthly, many teachers highlighted the importance of trust. They argued that the teaching of professionalism differs from regular education, and situations where students are trying out and experimenting with their future professional selves require psychological safety. As expressed by one teacher within social work:

If you [as a student] are insecure, you start thinking about the wrong things. When we run these exercises, and when we teach, we can contribute to creating a safe environment so that students can experience how it feels to act professionally. So they’re not stressed when they train. (Interview, social-work programme)

The cultural-discursive arrangements we identified around teaching professionalism revolved around the idea of a lack of verbalised consensus about the subject core. Even though the core content of professionalism teaching revolved around recurring keywords, we found that teachers expressed joint uncertainty regarding whether they shared a consensus about the subject core. Other ideas that emerged were those of exposure, realism, and complexity. Students should be exposed to realistic, complex, and challenging situations concerning empathy, interpersonal approaches, and self-awareness. These ideas shaped the learning activities to a large extent.

Regarding the doings of teaching, the documents provided us with a comprehensive overview of the types of teaching activities. Examples of such activities included joint reflection, discussion, and scenario training of professional situations. We observed that the learning activities were designed to a large extent to encourage reflection. Reflection could be arranged in many ways, ranging from structured and teacher-guided to unguided peer-reflection. Documents such as study guides and instructions provided many examples of this. Typical doings of teachers included introducing a written case, a situation the students had been exposed to earlier, or a snippet from a film, with the purpose of prompting joint and verbal or individual written student reflections on predefined themes or questions. Teachers described reflections like these as having the potential to create new perspectives among students, to provide avenues for discussing ethical issues, setting boundaries, or understanding aspects of professionalism at a theoretical level.

It was acknowledged that students need a theoretical knowledge base to understand what professionalism entails. A practical dimension, where students enact professionalism, was also described as important in teaching. The activities associated with the enactment of professionalism were regularly channelled through scenario training, during which students practised and applied their knowledge. A teacher from social work described the importance of direct social enactment in the teaching of professionalism:

I think it has to do with the practical exercises. That is, they [students] should be able to apply … the theoretical knowledge, but then I think it’s also in this very encounter with the client. The encounter and the approach to, and the relationship-building with the client, that they should be able to practise. It has something to do with skills. Then there’s knowledge too, of course, but there’s a lot about training skills. (Interview, social-work programme)

As the quote exemplifies, role-play where the students act towards each other or towards hired actors was seen as supporting insights regarding professionalism. In these activities, it was common for teachers to create realistic simulations designed to train situational flexibility and interpersonal behaviour. Many teachers strove to construct situations in which students were expected to behave and act in relation to patients or clients and make decisions in difficult situations. This was especially evident in the police training context, as stated by a police teacher:

 … they’re put in this situation to see what would happen if they were there as a police officer in this situation. What becomes very clear is how thoughts and feelings affect the situation. […] I will act very emotionally or based on physical reactions. I start sweating or shaking or something, and then I’ll maybe yell at someone or tell someone to back off, which is disproportionate to the situation. It becomes very clear to them. Wow, I need to learn things about this … about self-awareness. (Interview, police programme)

The ambition to include realism in the teaching of professionalism, coupled with the ideal of situational flexibility, became even more obvious in learning activities rigged with built-in ‘traps’ where students were tested through unexpected turns of events.

Regarding the material-economic arrangements associated with professionalism teaching, our analysis of the documents, particularly the schedules, revealed that this kind of teaching requires access to resources such as training facilities, training equipment, teacher resources, hired actors. These resources both enable and constrain teaching with a high degree of realism and frequency. While we have emphasised similarities across educational contexts, there were also variations in how the teaching was organised that relate to cultural, historical, and economic conditions. The police programme allocated significant resources to scenario training, encompassing time allocation, access to personnel, and equipment. Similarly, the medical programme allocated resources to ensure teacher attendance in the scenarios and prioritised the role-play and enactment of professional situations. However, the medical programme faced constraints on practice time due to curriculum overload. In contrast, the social-work programme had overall fewer resources, limiting the ability to have teachers present throughout a complete scenario training session. Instead, teachers rotated between independently working student groups, resulting in students often being left alone during their training.

Turning to relatings, in all three programmes, the teaching of professionalism differed from theoretically oriented courses in terms of how the social relations between students and teachers were arranged. Scenario training and reflection sessions regularly focused on discussions about students’ own actions, feelings, and opinions. Students sometimes had to expose their vulnerabilities, making professionalism teaching less anonymous than theoretically oriented courses. Furthermore, professionalism teaching was organised with the students at the centre of attention, and their enactment of professional situations was consistently scrutinised by others. For some students, this led to fear of acting and fear of making mistakes. For teachers, these situations meant struggling with balancing performance demands versus a psychologically safe setting. A central aspect of relating was also the level of trust between students. Students were cautious and tentative in their criticism and incredibly careful to be ‘kind’ to each other. This also prompted reactions from the teachers, who sought to reduce the pressure on students during scenario training by de-dramatising situations. The following observation note exemplifies this. It is an excerpt from an observation in which a teacher in the social-work programme was preparing a student immediately before scenario training:

Remember now when you go out, this is not about making a perfect counselling session, that is not the goal, it’s about getting to practise, and try things out. You need to start trying, try to meet an affect, and try to assume a certain social-work role. To gain experiences and learn from it. (Observation, social-work programme)

During the observations, it also became apparent that the teachers had ambitions to limit their impact and stay in the background, avoiding the provision of ‘correct’ answers or solutions. A common strategy involved teachers initially asking students to reflect on the exercise and subsequently providing their own feedback at the end of the session.

The social-political arrangements in an educational context inevitably involve a power relationship between teacher and student, establishing a stable social space. However, in our material of teaching professionalism, the power relationship deviated from higher education teaching traditions. The teachers expressed a conscious effort to establish a more fluid social space and downplay their authority to encourage students’ willingness and ability to practise and experiment. As articulated by a teacher in the medical programme:

I gain trust by showing that I can make mistakes too. You make mistakes and you don’t have to be so formal and structured as a teacher. You don’t have to be so damn good. You’re still good enough. (Interview, medical programme)

As suggested by this quote, the downplaying of the teachers’ professional role and proficiency was employed to diminish the social hierarchy and enhance trust and psychological safety. In general, the teachers emphasised the importance of facilitating a safe climate during practice. This involved efforts to build trust between the teacher and the students, as well as collaborative work within the group to cultivate trust among students.

Assessment of professionalism

We now turn to describing how the teachers worked to assess professionalism in the cases under study. An overview of the practice of assessing professionalism is presented in Table 3, using the theoretical concepts of TPA.

Table 3. Three central sayings were found during the analysis of the practice of assessing professionalism. Firstly, the idea that assessment is detrimental to learning, with students’ practise and scenario training being the primary focus. Teachers contended that students should not feel overly stressed about the eventual assessment of their capabilities. In response to why they choose to downplay the assessment aspect of an exercise, one teacher gave the following answer:

Because we don’t want to diminish their self-worth so early in such an important part of their upcoming job, because the risk is that, yes, they place very high demands on themselves and want to be so amazingly good in their performance. And then, we said from the beginning that the important thing is that they start practising, because they can’t be good at this until they’ve practised, practised, practised, and we don’t have time to practise, practise, practise, but we do have time to practise a little bit. So, it’s like the idea that they’re going to get it, that this … you can only get better. (Interview, social-work programme)

Secondly, that assessment was directed towards professionally uncertain and stressful situations. The scenarios were not routine and simple tasks; instead, they were designed to expose the student to uncertainty or stress by centering around highly challenging encounters. For instance, in the police programme scenario, we observed the task involved delivering a death announcement to a family member, a particularly demanding task even for an experienced police officer. Similarly, in the medical and social work programmes, the interactions with patients and clients were described as ‘tricky’. The patient or client was overwrought or agitated, and the cases did not have straightforward solutions. We interpret this as a ‘rite of passage’ rather than an assessment of competence. Simply being exposed to these situations was considered enough.

The cultural-discursive arrangements underpinning these sayings concern ideas about the future professional and what he or she will need to be able to handle in their future professional role. In addition, we also interpret the reluctance to assess performance as connected to an idea of fairness and objectivity when assessing students, which the teachers do not feel they can fully achieve.

Turning to doings, the ideas of a ‘rite of passage’ and exposure to stressful situations shifted the focus of assessment away from students’ performance during scenario training. Instead, all three programmes focused on the assessment of students’ reflections, whether written or oral, on their experiences. In interviews and documents, we saw a tendency to assess students’ reflection upon their performance, rather than the performance as such. In an exercise about ‘making clinical decisions’, one teacher on the medical programme expressed this as follows:

Respondent: Yes, funnily enough, on the part that’s about decision-making, we don’t have an assessment of ‘make decisions’ really, but there it’s more like this … ‘Hey you, now you didn’t make a decision’.

Interviewer: That would mean that as long as you’re there and active, you can then … what will be … What do you fail at then?

Respondent: Well then it will be like a discussion with the person responsible for the exercise. I go to them and say that ‘Axel here, he arrived too late, and he was … Sat fiddling with his phone, and besides, he only answered direct questions from me. He didn’t answer any direct questions from his peers, and he just didn’t have anything else. He’ll have to do it [the exercise] again.’ (Interview, medical programme)

This quote also reflects another central doing concerning assessment, namely the ‘administration of active attendance’. Aligned with the idea of exposure, it was important that the student attended actively, i.e. contributed to the reflection as well as acted in scenarios. ‘Passing’ an assessment was, in many cases, about actively showing up.

Another aspect of doings is that the teachers were (deliberately or unintentionally) vague about whether an exercise or scenario training was indeed an assessment. There was thus ambiguity in instructions. The teachers emphasised the training aspect and downplayed the assessment aspect. As an example, one exercise in the medical programme gives the following instructions to students:

The subject guide contains additional information about, for example, expected learning outcomes. If you are absent from parts of the exercise, there is a risk that the teachers’ basis for assessment is insufficient. (Instruction to exercise, medical programme)

In other words, it was unclear whether the exercise was assessed at all, and how much of it was mandatory. Furthermore, students were not directly informed that the exercise had expected learning outcomes that would be assessed, nor what these outcomes were.

The material-economic arrangements identified as important were teacher time and resources. The number of students to assess individually were substantial. Time allotted for the exercise, the use of actors and equipment, etc., has an impact on the possibility to assess students.

Concerning relatings in the assessment of professionalism, the most evident relation was the asymmetrical power relation between teachers (sometimes tutors) and students. On the one hand, teachers made efforts to create a safe climate to facilitate students’ growth while on the other hand, they struggled with fulfilling the role of a government official and assessing students. This dilemma reinforced the power relationship. As much emphasis was placed on ensuring reflective discussions among students, the dynamics within the student group and student-student relationships also became central. We saw plenty of evidence that students took these exercises very seriously and even became emotionally involved. The following situation from the police education occurred during an observation of the ‘bereavement and loss’ exercise. We met the students immediately before they started the role-play:

The students exhale noticeably heavily and whisper ‘oh sh*t’. They’re taken aback by the fact that this is going to be hard … They walk up the stairs with heavy steps, the students are clearly affected, and walk with heads lowered. ‘My’ patrol knocks on the door to the surprised actor who opens it. The students introduce themselves; ‘We come from the police, and we have bad news’, they say. They are admitted. The mood is palpable. (Observation, police programme)

We would like to emphasise that, given the setup of these exercises, this kind of engagement from students is a prerequisite for the exercise to ‘work’ as an assessment in this context.

The social-political arrangements that we identified as important concern the role of the teacher as a person who, in the Swedish system, exercises public authority by assigning grades. Furthermore, the regulations for assessment are governed by national guidelines and laws, along with local university guidelines, which determine the possibilities for designing assessment practices. These regulations encompass, among other things, that each student must be assessed individually, and that the syllabus stipulates what the teacher can and cannot assess in a given course.

Discussion

An initial observation reveals that our TPA analysis concentrated on identifying common elements among three distinct educational programmes. Surprisingly, numerous emergent findings and challenges consistently surfaced. In accordance with Eisenhardt and Graebner's assertion (2007), cross-case similarities serve as an indication that empirical results form a robust foundation for theorisation. However, effective theorisation demands the incorporation of theoretical concepts and tools to comprehend emergent phenomena. Employing TPA, we framed teaching and assessment as separate yet closely interrelated practices within the educational programmes during our analysis. Adopting this approach, we delve into two persistent and seemingly universal issues within professionalism education: entangled practices and assessment avoidance.

The problem of entangled practices

A central concern for educators in all three educational contexts revolved around addressing the tension arising from conflicting demands related to teaching and assessing professionalism. In line with Mahon et al. (2017), we characterise this as an ‘entanglement’ of practices. The terms ‘entangled’ or ‘enmeshed’ denote the intricate relationship between practices and arrangements. Broadly speaking, we associate it with a complex interweaving of teaching and assessment practices, giving rise to tensions within professionalism education.

From a TPA perspective, this tension arises from the conflation of teaching and assessment practices that align with a common objective, namely, the development of students’ professionalism. Additionally, although teaching and assessment may exhibit surface-level differences, these practices share comparable constraining and facilitating frameworks, encompassing cultural and historical roots, jurisdictional boundaries, and material and economic conditions. Consequently, we assert that in professionalism education, teaching and assessment often intertwine and are not distinctly separated in time and space, deviating from the structure seen in many ‘traditional,’ sequentially organized, subject-focused courses within higher education (Biggs and Tang 2011).

A challenge arising from the closely intertwined teaching and assessment practices is that educators find themselves tasked with two conflicting responsibilities. On one hand, from a teacher's standpoint, professionalism education involves orchestrating activities characterised by psychological safety, experimentation, and opportunities for students to embody their potential ‘future professional selves’ (Hopwood et al. 2016). As evidenced in our findings, many teachers, in order to support these aspects of educational activities and facilitate learning, preferred assuming a more supportive role, acting as facilitators, and downplaying a dominant position. On the other hand, teachers are also mandated to evaluate student activities in alignment with higher education regulations. Additionally, the teacher serves as a gatekeeper for the professional community and is expected to impartially assess professional conduct, performance, and skills (Lindberg 2012). While these aspects are crucial for ensuring fair and objective assessment, they can be detrimental to the learning experience and presuppose hierarchical relationships between teachers and students (Winstone and Boud 2022). From a TPA perspective, we conclude that the social dimension is where the disparities between teaching and assessment practices become most apparent. Specifically, differences in how students and teachers interact emerge in the social dimension. Our findings indicate significant variations in social dynamics and the distance between students and teachers, depending on whether an activity is geared towards learning or assessment.

In conclusion, the interweaving of teaching and assessment practices in professionalism education appears to result in a pervasive paradox within evaluated learning activities. The term ‘learning’ inherently implies a focus on training (and failing). This duality can be perplexing for students, creating a sense of uncertainty – 'Are we here to train or to be assessed?’ While scenario training can be structured for either learning or assessment purposes, these distinctions often blur in professionalism education. A way of addressing this problem could be to incorporate formative assessment as a method. However, awareness and central features of formative assessment is lacking in these studied programmes. The examination of professionalism methods and assessments highlights a tension between, on one hand, the aspiration to provide a platform for practising and instilling confidence in students to experiment and learn from mistakes, and on the other hand, the formal requirement to assess learning objectives in a manner consistent with other subjects within higher education.

Assessment avoidance

This tension presents a dilemma for teachers in deciding what to prioritise when faced with simultaneous yet incompatible courses of action. In such scenarios, a notable trend in this study is that teachers tended to prioritise favourable activities from teaching practice, while actively seeking workarounds for assessment practices. This phenomenon is encapsulated by the term ‘assessment avoidance’.

As demonstrated in the findings section, assessment avoidance manifested in various ways. Examples include teachers refraining from using the term ‘assessment’ deliberately, opting for vagueness to maintain an undisturbed learning climate during training sessions and simulations. Another approach involved minimal assessment, such as establishing ‘active attendance’ as the criterion for passing. A common strategy was to attempt to separate assessment practices from teaching practices in either time or space. For instance, some teachers assessed students’ reflections on their actions rather than evaluating the actions and professional performance themselves. This detachment means that teachers refrain from directly judging students’ actions in professionalism education and instead assess their subsequent narratives, reflections, and expressions regarding professionalism.

While this study did not specifically delve into why teaching professionalism is favoured while assessment takes a backseat, other research has indicated that evaluating practical skills and the adherence to professional norms is challenging and intricate. Moreover, teachers often associate their identity more with that of a facilitator for learning than a gatekeeper (Cruess, Cruess, and Steinert 2019; Neve, Lloyd, and Collett 2017).

We are not primarily advocating for heightened assessment of professionalism in undergraduate programmes. There may be valid reasons to de-emphasise assessment and promote experimentation in behaving as a ‘future professional self’ early in the curriculum (Hopwood et al. 2016). However, a challenge associated with persistent assessment avoidance is the emergence of a mismatch between activities, assessment practices, and learning outcomes. This misalignment can be examined as a disparity between an ostensive and a performative aspect of professionalism.

As highlighted in our findings, ostensive narratives regarding professionalism emphasise that the most crucial activity for developing professional skills is through repeated ‘doings’ in various simulated professional settings. However, as our study reveals, these actions are not assessed at a performative level. Consequently, it can be inferred that there is a misalignment between what is declared as important and the activities that define practice. This misalignment also carries the risk of creating issues down the line. For example, if these ‘doings’ are not assessed, the challenge of identifying and addressing inappropriate or undesired behaviours becomes more daunting. Moreover, misalignments between the stated importance of learning outcomes and what is assessed may further reinforce the persistent issue of students often perceiving professionalism as vague, abstract, and unclear (cf. Leo and Eagen 2008; Neve, Lloyd, and Collett 2017).

The objective of this study was to uncover common practices in teaching and assessing professionalism. While this research sheds light on teachers’ perspectives and classroom interactions between teachers and students, it has a limitation: the absence of students’ voices in expressing their views on the teaching and assessment of professionalism. A comprehensive analysis of the student perspective requires dedicated research and stands as a significant area for future studies, given that students are the focal point of the practices aimed at fostering professionalism. In addition, the focus on one type of training session for each program makes generalisation challenging, but the identification of cross-case similarities reinforces the empirical findings. A limited number of sessions were supplemented by interviews in which teachers provided insights into their teaching methods in general and various types of training sessions. In aggregate, this contributes to the discourse on how practices can be structured to further the development of professionalism and how diverse arrangements impact this dynamic.

Conclusion

In this study, we employed TPA to scrutinise how teaching and assessment practices in professionalism courses across three educational programmes in Sweden are both enabled and constrained. As emphasised by Mahon et al. (2017), it is crucial to critically examine one's own teaching practices for development. Notably, our analysis offers a theoretical elucidation for three persistent issues that arise during professionalism courses. These issues can serve as a basis for questioning and enhancing the teaching and assessment of professionalism.

Firstly, the perception of teaching and assessment as entangled practices elucidates why challenges such as the confusion between learning and assessment are prevalent in professionalism education. We explored this phenomenon in terms of the paradoxical nature of ‘the assessed learning activity’.

Secondly, this study revealed that the entanglement of teaching and assessment practices introduces complexity, ambiguity, and vagueness into activities like training sessions and simulations. Considering the potential perception of professionalism as irrelevant or vague in content, this finding explains why such perceptions may arise.

Thirdly, we observed a tendency among teachers to prioritise constructive learning activities over assessment practices when these practices were conflated and allowed for different courses of action. This, in turn, resulted in what we have termed ‘assessment avoidance’.

The issues highlighted in this study present an opportunity for practitioners to take transformative action. Implementing changes in educational practices is a challenging endeavour, yet it is imperative to mitigate the evident problems and to ‘continue to strive to understand the conduct and consequences of our practices’ (Mahon et al. 2017, 257). Without such changes, there is a risk that professionalism education will persist in its lack of clarity, potentially leading students to enter professional practice without the ability to meet its expectations and demands of professionalism.

Availability of data and material

The datasets generated and analysed during the current study are not publicly available to protect the identity of the participants, but sections of the data without identifiers are available from the corresponding author on reasonable request.

Authors’ contributions

The first author did most of the data collection and writing the article, while all authors have made substantial contributions to writing parts of the article, design, conception, data collection, analysis, discussion, and critical readings. All authors have approved of the text prior to submission.

Acknowledgements

According to the Swedish Ethical Review Authority, this research does not fall within the ethical legislation as we do not collect or process any sensitive data. The study thus meets the national guidelines regarding research ethics requirements.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded internally by Umeå University.