Letter to the editor regarding the article “understanding medical professionalism using express team-based learning; a qualitative case-based study”

KEYWORDS:

• Medical Professionalism
• Identity formation
• Medical education
• Equality
• Diversity
• Inclusion

Dear Editor,

We express our enthusiasm for Guraya and colleagues’s article [1] and commend their exploration of a pertinent aspect of medical education. The study investigates the understanding of medical professionalism (MP) in undergraduate medical students using expressed team-based learning (e-TBL) and thematic analysis. The authors identified four main themes for integration into teaching MP. As medical students and doctors in the United Kingdom (UK), we appreciate the findings of the study and offer our own perspectives on the education of MP.

The authors aptly reference Vygotsky’s sociocultural cognitive learning theory [2] and Bandura’s social cognitive theory [3] as influences on professional identity and development. Contextualizing this study within the UK’s diverse medical landscape; where NHS-employed doctors comprise 50% white, 32% Asian, and 5.9% Black individuals, with 39% of UK medical students representing Mixed, Asian, Black, or other ethnic backgrounds [4]; the potential for shared perspectives and enhanced empathy is evident. We noticed the missed opportunity of analysing the difference in results of the VSAQs for the students in Bahrain and Ireland, to see if the difference in culture had affected the understanding of medical professionalism.

The study employs e-TBL to foster professionalism understanding, although we observe potential limitations in its reflection-promoting capacity. Reflection, pivotal in medical education, nurtures self-growth and identity formation, aligning with the authors’ emphasis on professionalism’s role in shaping one’s medical identity. In this context, we see medical professionalism in lieu of the definition stated by the Royal College of Pathologists [5] as ‘a set of values, behaviours and relationships that underpins the trust the public has in doctors’. This links to Erikson’s [6] theory of identity formation as medical professionals must conceptualise their role in this trust the public has in them, reconstructing their actions, behaviours and therefore identity accordingly. In the UK, assessment of professionalism often outpaces its instruction. UK students’ professionalism is evaluated through written reflections and supervisor input, as well as historical use of situational judgment tests.

While commendable, the study’s focus on a singular professionalism module may risk oversimplification. We emphasize the importance of practical application and iterative learning, referencing Kneebone’s work in surgical training [7]. Very short answer questions (VSAQs) might need to be more concise in order to capture the intricate realities necessitating nuanced exploration.

Braun and Clark’s 6-step thematic analysis suggests that rigorous analysis, especially in qualitative research’s complex data interpretation stage, is pivotal. While the authors provide methodological insights, further detail on analysis methods would enhance clarity. Thematic analysis’s accessibility, perspective investigation, and insight generation are acknowledged. Compared to other methods, a thematic analysis is disadvantaged because it prevents the researcher from making claims about language use [8]. The flexibility afforded by thematic analysis can lead to inconsistency and incoherence when generating themes derived from the data [9].

The study’s micro, meso, and macro identity levels, stemming from theme III, should be viewed as interconnected, avoiding assumptions of their independence. The concept of intersectionality, as pioneered by Kimberle Crenshaw, resonates here, suggesting identity heterogeneity influences professionalism outcomes [10,11]. Investigating factors like age, gender, and year of study’s influence on results, alongside the impact of clinical exposure, presents avenues for future exploration. We suggest considering sociocultural factors and upbringing impact as explored by Jha and colleagues [12].

In conclusion, our letter dissects Guraya and colleagues’ study, offering valuable insights into the understanding of medical professionalism and its application across UK medical schools. We aim to emphasise the significance of diversity within the medical profession and highlight how different cultural contexts can shape the understanding and practice of medical professionalism.

Disclosure statement

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

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.