Turkish students’ perceptions of professionalism at the beginning and at the end of medical education: a cross-sectional qualitative study

Figures & data

Table 1 Analysis steps

Stage	Step	Function	Aim
Comprehensive understanding/recontextualization	7	Interpretation	Reaching an understanding and insight
Structural analysis/decontextualization	6	Mapping	Reconstruction of the data: Defining the pattern of relations between contexts, themes and sub-themes
	5	Charting	Creating tables for contexts, themes and sub-themes
	4	Indexing	Debate and consensus on the themes set
	3	Cross check of the defined themes	Identification of a thematic framework
	2	Deconstruction of the raw data	Extracting relevant answers to questions
Naïve understanding	1	Rough reading	Familiarization

Table 2 The thematic pattern of the students’ expressions concerning connotations of ‘being a physician’

Connotations about ‘being a physician’– The thematic pattern
			Theme
+/−	Level	Dimension	Grade-1	Grade-6
Positive	Individual	Being a good person	Having sedateness Being altruistic Being genial Being merciful Showing empathy	Having sedateness Being altruistic
		Being a good professional	Being experienced Being knowledgeable and skillful Being trustworthy Being coldblooded Being responsible Giving people hope Having communication skills Saving lives	Being experienced Being knowledgeable and skillful Healing people
	Societal		Profession as a special means of communication with people Improving the quality of life of people	Profession involving a one-to-one communication
Negative	Individual		–	Weariness Sleeplessness
	Societal		–	Being exposed to violence

Table 3 The components of the dimension of ‘being a good professional’ and behaviors unfit for ‘a good physician’ extracted from students’ accounts–themes/sub-themes/samples

		Being a good professional		Behaviors unfit for a ‘good physician’
		Sub-theme		Samples
Context	Theme	Grade-1	Grade-6	Grade-1	Grade-6
Professional responsibility	Relying on scientific knowledge	Doing the right thing scientifically	Doing the right thing scientifically	–	–
	Competency	Being knowledgeable and skillful	Being knowledgeable and skillful Being able to update knowledge	‘Being incompetent in terms of knowledge and skills’	–
	Accuracy	–	Attentive conduct of the profession Giving the right treatment Making an accurate diagnosis	‘Giving unnecessary treatments’ ‘Jeopardizing the patient's life with malpractice’ ‘Ordering unnecessary tests’	‘Being late for consultations or not showing up at all’ ‘Delaying the tests’ ‘Medical errors or negligence because of lack of knowledge and/or insensitivity towards patients’
	Objectivity	Acting unbiased	Acting unbiased	‘Not treating patients equally’ ‘Acting unbiased’ ‘Changing her/his behavior according to the persons’ appearance’	‘Not treating patients equally’ ‘Favoring private patients’ ‘Tending to treat patients badly because of their worldviews’
	Being principled	Keeping financial interests in the background while conducting the profession	Prioritizing the professional responsibilities	‘Performing unnecessary medical interventions to acquire unfair profit’ ‘Viewing medical professional just a means for making money’ ‘Viewing patients as customers’	‘Reflecting her/his own personal matters onto her/his professional life’ ‘Regardless of the expected benefit, giving treatment/prescribing drugs to please the patient’
	Being able to work under pressure	Being able to think fast Being able to make decisions under pressure Cold-bloodedness	Being able to think fast	–	–
	Being a researcher	–	Making research	–	–
	Being an educator	–	–	–	‘Not being a good educator’ ‘Not sparing time for educational duties’
Physician-patient relationship	Empathy	Establishing empathy with patients Being a good listener Sensitiveness to patients’ suffering	Establishing empathy with patients Being interested in patients Understanding patients	‘Being indifferent to the patient's suffering’	‘Being insensitive while breaking bad news’
	Trustworthiness	Reliability Not viewing patients as customers	Being accessible	‘Behaving indifferent towards the patient’ ‘Insensitivity’ ‘Reflecting her/his own personal concerns onto her/his relationship with the patient’ ‘Viewing patients as customers’	‘Being inaccessible’ ‘Not being close to the patient’
	Communication	Being comprehensible/understandable Informing patients Having communication skills Being promising/giving hope Debonairness Relieving patients	Being comprehensible/understandable Informing patients/their relatives Having communication skills	‘Behaving rude/inattentively towards patients/their relatives/third parties’ ‘Having a high ego’ ‘Looking down upon others in her/his relationship with patients’	‘Not providing the patient with adequate information/not informing the patient’ ‘Not touching the patient’ ‘Misbehaving towards the patient’ ‘Being angry and/or straight-faced’ ‘Not listening to the patient’
	Respect for patients’ autonomy	Showing a caring attitude Acting without prejudice in the relationship with patients	Showing a caring attitude	–	‘Using a language disrespectful to the patient's personality’. (e.g.,: ‘shooting the patient’, ‘pickle patient’) ‘Taking care of the patient as a human being, not just the illness’
	Fidelity	–	Following up the patient Not letting the patient down	‘Neglecting the patient’	–
	Holistic treatment	–	Evaluating the patient in relation with her/his environment	–	–
	Respect for patients’ privacy	–	–	–	‘Being disrespectful towards patients’ privacy’
Physician-physician/healthcare professional relationship	Teamwork	Being able to work as a part of a team Having good relationships with colleagues	Being able to work as a part of a team Having good relationships with colleagues	–	Abusing professional hierarchy (‘assigning subordinates with heavy workload’)
	Competition	–	Being aware of her/his responsibilities towards colleagues	–	‘Competing with colleagues’
Responsibility of the physician as an intellectual	Openness	Having flexible value judgments	–	–	–
	Being active	Being socially active	–	–	–
	Leadership	Being a model for people around	–	–	–
	Having opinions on paramedical issues	Being lettered	–	–	–

Table 4 The thematic classification of students’ opinions upon the education program currently being implemented in AUFM in the context of ‘being a good physician’

‘If you ever had a chance, what advices would you give to the institutional administrators in order for them to be able to raise good physicians?’
		Theme/Opinion
Context	Dimension	Grade-1	Grade-6
Structuring education programs/curriculum	Substructure	The impossibility of education in crowded classes	The impossibility of education in crowded classes
	Theory/practice balance	Education should be integrated. Students should be able to get in touch with patients in the early stages of education. Clinical studies should start earlier. The program should not be based on memorizing.	Education should be integrated. Students should be able to get in touch with patients in the early stages of education. Most of the education should be practically given at the bed-side. The professional skills practices should be made with patients in the first 3 years. There should be practical work in the first 3 years.
	Communication education	–	Communication education should be given at the clinics too.
	Educational objectives	Education should be in accordance with the real life.	Education should be in accordance with the real life. It should be aimed to raise general practitioners.
	Structuring education programs	Education and the educators should be shaped according to the student feedbacks. Self-studying/self-learning opportunities should be enabled.	Education and the educators should be shaped according to the student feedbacks. Self-learning skills should be taught to students. The professor-student interaction should be increased in basic medical education. Professors should be present at the educational activities at the clinic.
Educator/instructor-student relationship	The effect of role models	The educator-resident-student communication should be strengthened.	The educator-resident-student communication should be strengthened.
Healthcare system	Structural problems	–	Educators should work full-time. Pay for performance system should be abolished. The time spared for each patient should be increased. TUS should be repealed.