Learning professionalism using creativity and diversity concepts

ABSTRACT

Clinical relevance

Professionalism is a multidimensional sociocultural construct that is abstract, evolving and context-dependent in nature. This has made the teaching and assessment of professionalism in healthcare complex and challenging. A lack of professionalism can increase patient risk and litigation.

Background

This article examines group creativity and diversity across healthcare and non-healthcare disciplines and how they can assist students in constructing their own understandings and knowledge of professionalism. It is proposed that linking professionalism to creativity will improve understanding on how to help students studying healthcare learn about professionalism better.

Methods

A total of 30 students from different tertiary levels and across disciplines participated in the study. They explored either a gallery or museum and examined an artefact relating to professionalism. Learning experiences were evaluated via survey results and thematic analyses of their reflective essays and semi-structured interviews.

Results

Participants reported increased understanding of professionalism and appreciation of perspectives and skills of others. The creative aspect of the task was fun and engaging, and group diversity enabled different opinions and perspectives to be heard and shared. This is analogous to a professional working environment. Themes generated from the essays were: (a) intrinsic motivation, (b) diversity, (c) learnings of professionalism, and (d) challenge encountered.

Conclusion

The results of this research make a meaningful contribution to existing literature by empirically demonstrating that students from different disciplines could better construct their own understandings of professionalism when their learning activities were performed in an authentically creative and diverse setting. This educational concept is underpinned by diverse types of creativities that are not mutually exclusive. It is hoped that this first piece of evidence will stimulate more studies on utilising group creativity and diversity in healthcare education.

KEYWORDS:

• Creativity
• diversity
• optometric education
• professionalism

Introduction

A significant body of literature has been published during the last 70 years that documents the individual, social and cultural benefits of connecting with others.^1–3 The connectedness learning approach proposes that activities such as mentoring and collaborative problem solving with industry and community partners boosts productivity, improves confidence and supports skill development, thereby allowing people to prosper in their career pathways.^4–6

Yet, such approaches remain hindered by the bounded nature of institutional policies and structures. It is challenging to collaborate across disciplines due to specific content knowledge, transmissive pedagogies and a lack of connecting with the industry and community for teaching.⁶ Professionalism involves connectedness; it is context-dependent⁷ and is a multidimensional sociocultural construct.⁸ Therefore, facilitating the learning of professionalism in higher education is likely to be enhanced by designing a context that would enable students to collaborate across disciplines within the University and beyond.

This study took a constructivist, student-centred and active pedagogical approach to design contexts in which students could construct their understanding of professionalism. Attempts to analyse how students created their understanding of professionalism led to the literature concerning team-level creativity.^9,10 Key concepts from creativity research were used to analyse how students learnt in this context. These included intrinsic motivation hypothesis for creativity¹¹ and the notion that diversity in teams increases the probability for lateral associations to be made.⁹

Work on productive conflict and differences between groups ‘feeling’ creative as opposed to ‘being’ creative due to negative associations with conflict was considered.¹⁰ Likewise, the roles that conceptual combination, metaphor, and analogy play in group creative processes were also considered.¹²

Both concepts of creativity and professionalism can be fostered when people are exposed to new processes and ideas from different disciplines, and when they cross institutional boundaries.¹³ Further, the link between creativity and professionalism also relates to lifelong learning. People need to continually invest in themselves via education and training to maintain and increase their knowledge and skills, which would enhance productivity.¹⁴

Organisations need people who possess effective communication and work well in teams, which is a hallmark of professionalism. In conjunction with the ability to think creatively, being flexible, and adapt quickly, all these attributes are likely to increase employability.¹⁵ Creative ideas can be brought to fruition through social networks,¹⁶ and such networks and ideas are vital for sustaining both employability⁶ and professionalism.

This project primarily concerns mini-c creativity as this notion provides conceptual clarity regarding the creativity inherent in the learning processes of participant. It is defined as the ‘novel and personally meaningful interpretation of experiences, actions, and events’.¹⁷ This type of creativity sits alongside Pro-c creativity, little-c, and Big-C creativity in their Four C model.

Pro-c creativity is also relevant since it involves ‘the developmental and effortful progression beyond little-c that represents professional-level expertise in any creative area’.¹⁸ Therefore, when discussing the learning of professionalism here, it refers to our participants’ mini-c creativity through which they created their own understandings of professionalism and associated ‘ways of being in the world’. Participants’ understandings of how they can develop their Pro-c creativity is also discussed.

The proposition that creativity ‘has three modes of existence or ways of being in the world’ is also relevant.¹⁹ The first mode is visceral (embodiments), which is physically located in space and time, and is a visceral and embodied form of expression. The second is ideational (mind and conceptual), which involves the mental mode of thinking and imagining. The final mode is observational (appreciation, critical, and evaluative), which includes how ‘creativity, creative practices, and creative works are seen, positioned, and evaluated in systems, in groups of people, and within individuals.

These definitions of creativity can be linked to those of professionalism. As a multidimensional sociocultural construct,⁸ professionalism is abstract, evolving and context-dependent in nature.⁷ Thus, the teaching and assessment of professionalism in healthcare can be complex and challenging. Despite extant literature and research in this area, there is still no singular consensus regarding how to conceptualise professionalism. A lack of professionalism in a health care setting exposes patients to poor quality care and harm, which in turn increases the risk of patient complaints and litigation.²⁰

This study examines group creativity and diversity across healthcare and non-healthcare disciplines and how they can assist students in constructing their own understanding of professionalism. No studies have evaluated the teaching and learning of professionalism in a synchronous multi-disciplinary context. The research questions driving the study were: (1) How do students describe their experiences participating in an interdisciplinary group work project that facilitates creativity and diversity? and (2) What have students learnt about professionalism?

Methods

This study engaged students across six disciplines from different tertiary levels. The data collection approach was mixed-methods (both quantitative and qualitative). The reason for mixing methods was to triangulate different but complementary data on the same topic to best address our research questions via convergence, corroboration and correspondence of results from different methods.²¹ Quantitative data was collected – obtained by surveying the students – and qualitative data through reflection essays and semi-structured interviews. All data were analysed concurrently, but separately, and brought together for interpretation.

This study conformed with the tenets of the Declaration of Helsinki. The project was approved by the University of Melbourne’s Faculty of Medicine, Dentistry and Health Sciences Human Ethics Advisory Group (Ethics ID: 1953601). Prior informed consent was obtained from all participants.

A total of 30 students participated in the study which was conducted in 2019 (Table 1). There was a total of seven groups with four to six students in each group. The study design expanded upon earlier research by the lead author²² who has expertise in health professional education and object-based teaching interventions. The activity was purposely designed to be open-ended, allowing participants to employ strategies, resources, and techniques to achieve the outcome as described below. All participants were involved from the beginning to the end of the group work. A more detailed description of the group work activity is outlined in Figure 1.

Figure 1. A description of the group work activity.

Table 1. Number of disciplines and students involved.

Discipline	Tertiary level	Number of students
Biomedicine	Undergraduate	7
Oral Health	Undergraduate	4
Dentistry	Postgraduate	6
Optometry	Postgraduate	9
Arts	Postgraduate	3
Film/TV	Postgraduate	1

Participants were given six weeks to participate in the group work. To complete the task, the participants needed to navigate all phases of the creative process.²³ The three modes of creativity¹⁹ are useful here for outlining the basis for this group work. This involved the initial and subsequent visits to the gallery or museum, deciding on the final artefact, and the production of the final video. A week later, participants were invited to complete an anonymous online survey, submit an individual reflection essay, and participate in a semi-structured interview.

The interview lasted approximately 30 minutes, with participants being asked to comment on: (1) the interdisciplinary group work (observational mode of creativity), (2) the artefacts in the gallery or museum that they used to learn about professionalism (visceral mode of creativity), and (3) the concept of professionalism that emanated from the group work (ideational mode of creativity).

The interviews were audio-recorded and transcribed verbatim by an independent researcher. The transcriptions were reviewed, proofread and checked for accuracy by the lead author before they were analysed. An amendment was made if words in the transcripts were misspelled, misplaced or wrongly inserted. No amendment to the transcriptions were performed.

Descriptive methods were used to summarise the percentages and median of the survey responses. A Cronbach’s alpha test was conducted to determine if the survey (multiple-question Likert scale) was reliable. Outcomes of the study were analysed using an inductive approach to thematic analysis of the essays and the interview transcripts, as outlined in the six-step process by Braun and Clarke.²⁴

Each author familiarised themselves with the data independently to generate relevant codes. These codes were then condensed to obtain a summary of the key points and common meanings that recurred throughout the data. Themes were then actively generated, reviewed, and refined until agreement was reached.²⁵

Results

A total of 21 students (70% response rate) completed the survey (Table 2). The discipline breakdown was Optometry: 9; Dentistry: 5; Biomedicine: 5; Oral Health: 1, and Film/TV: 1. The students reported spending between one to six hours visiting the gallery or museum. The common sites were the National Gallery of Victoria, Melbourne Museum, and the Percy Grainger Museum at the University of Melbourne. The artefacts selected were diverse, such as a pocket watch or a photo of a white man and an Aboriginal man.

Table 2. Students survey findings.

Questions	Strongly Agree	Somewhat Agree	Neither Agree nor Disagree	Somewhat Disagree	Strongly Disagree
1) I had a clear understanding of my responsibilities in this group work.	52%	43%	5%	0%	0%
2) My understanding of peer-assisted teaching and learning has improved as a result of this group work.	38%	48%	14%	0%	0%
3) My understanding of inter-disciplinary object-based learning has improved as a result of this group work.	48%	38%	14%	0%	0%
4) I am more open to giving and receiving peer feedback as a result of this group work.	38%	48%	14%	0%	0%
5) My understanding of professionalism across different disciplines has improved as a result of this group work.	43%	52%	5%	0%	0%
6) My communication and inter-personal skills have improved as a result of this group work.	48%	43%	9%	0%	0%
7) I have a better understanding of the perspectives and skills of students from other disciplines as a result of this group work.	52%	48%	0%	0%	0%
8) I find this group work to be more beneficial compared to previous experiences.	29%	43%	28%	0%	0%
9) I find this group work to be more enjoyable compared to previous experiences.	48%	38%	5%	9%	0%
10) Group work activities involving object-based learning using museums and galleries should be incorporated into future teaching programs.	48%	29%	23%	0%	0%
11) Group work activities involving cross-disciplines should be incorporated into future teaching programs.	62%	33%	5%	0%	0%
12) Group work activities involving both undergraduate and postgraduate students should be incorporated into future teaching programs.	52%	29%	14%	5%	0%

High internal consistency and reliability of the survey responses was indicated by a Cronbach’s alpha of 0.82. The median value was between 4 to 5 for all questions. This implied that the group work was highly valuable and beneficial for all students. There was strong agreement from all students that this group work increased their knowledge of professionalism across different disciplines. The project augmented their professional development, with approximately 90% of the students reporting that the task had helped improve their communication and inter-personal skills.

All students agreed that the group work had increased their understanding of interdisciplinary learning and their appreciation of the perspectives and skills of students from other disciplines. Most of the students recommended future group work assignments should incorporate various disciplines and tertiary levels. A total of 62% of the students provided comments in the free- text box. One student wrote: This was a unique experience. Though I had done an object-based professionalism project before, I had never done a group project involving people from other disciplines. The different skills and life experiences people brought to the table opened my mind up to the different perspectives available in the context of professionalism but also group work, clinical practice and creative thinking.

Another student said: Overall, I enjoyed the whole process. As this is the first time that I have group work that’s outside the subject assessment, it provides a whole new perspective in terms of how you put forward your ideas, how do you reach a consensus, and how to negotiate. I think it is definitely helpful in terms of understanding professionalism, as it is a rather abstract concept that needs to be put under the real-life situation so that one can grasp the core values it conveys.

A total of 17 students (57% response rate) submitted their reflection essays, and 20 students (67% response rate) participated in the interviews. Similar themes were identified and hence they were presented together. The themes were:

Intrinsic motivation

Students reported that this group work was fun and engaging. The collaboration was refreshing, and they enjoyed the freedom of this project. They could be creative, and they thrived in this pedagogical context of autonomous learning.

Diversity

Students initially thought this project encompassing art in a gallery or museum was going to be challenging since most had minimal exposure to the arts and humanities whilst studying. It took them out of their comfort zones. They had to diverge their thinking to be creative, and then converge to achieve relationality with their core disciplinary context and the theme of professionalism.

This project helped them to consider their personal growth and develop a sense of respect for participants from diverse cultures and disciplines. The group diversity enabled different perspectives to be put forward and for lateral associations to be made through their projects. Overall, students felt that this was a good learning opportunity to apply, learn, and attain generic skills required for their future workplaces.

Learnings of professionalism

The students constructed their own understanding of professionalism as per the aims of this study. The active learning in a physical environment through observing their peers and self-reflection was highly regarded by the students. They acknowledged that the interpretation of professionalism is contextual and multifactorial. The notion of communication, respect and teamwork was often mentioned.

Challenge encountered

The main challenge was finding a common time to suit everyone due to different schedules and juggling personal and work commitments.

Discussion

This study has empirically evaluated experiences of healthcare and non-healthcare students in a group task that facilitated creativity and diversity through an interdisciplinary lens for learning about professionalism. Context was provied in this work whereby the participants could construct their own knowledge of professionalism. This project has encouraged students to diverge their thinking and gave them a wider view into what professionalism could entail. The existence of various moral compasses is inevitable in life, and students have reflected and showed an understanding of what it means to compromise, negotiate and resolve differences. Allowing this process, the students were then able to think convergently to complete the project.

Teaching professionalism through a traditional subject-centred curriculum can limit learning experiences. Active student involvement, self-directed learning, promulgating interest, and a motivation to learn can facilitate effective learning of professionalism.²⁶ Utilising a gallery or a museum as a provocative and creative environment enabled the students to consider the visceral mode of creativity.¹⁹

By being encouraged to view and/or feel the representation or expression of professionalism in a tangible or visible form, students could consider whether the concept of professionalism was capable of embodiment. Through being asked to choose an artefact to which they could link their conceptions of professionalism (ideational mode of creativity), the student groups were required to engage in metaphorical thinking¹² to consider the extent to which professionalism could embody a tangible or visible form.

Regarding this process, one student noted: I think going to museums first of all you provided us with a new space to explore new ideas and also break the ice especially since we didn’t know each other beforehand. So, asking questions like: What did you think about this artefact? What did it symbolize? You pushed us to think from new perspectives and relate ideas and brainstorm just by looking at simple objects. So, I was amazed by how artwork can evoke emotion and bring up new thoughts at the same time.

This group work also formed a prompt for the students to reflect on their collaborative processes, engaging students in the observational mode of creativity.¹⁹ This meant that they could appreciate, critically reflect on, and evaluate how their groups went about the task. For example, one student reflected that: I thought it was good when we were at the gallery that we went to, and we all decided to just pick random artworks that we liked, not necessarily having anything to do with professionalism. And then it was good seeing how other people’s minds worked when they tried to relate to professionalism. Because everyone would have their own definition of professionalism. But then when you see how other people think, you kind of have a more diverse meaning of the word. Because you saw how this person reacted to this, and this and that.

In this observational mode of creativity, students were able to acknowledge the role that ‘difficulty’ and ‘conflict’ play in group creative processes. Diversity of team membership can lead groups’ creativity in more lateral directions, thus potentially creating more conflict between members.⁹ While this can be problematic because ‘conflict can affect the mood of an individual, rapport with others, and even patterns of thinking’⁹ leading their thought processes to become rigid and narrow,²⁷ some types of conflict – specifically task-based conflict – can in fact aid the creative process.²⁸

Therefore, while divergent thinking and openness are correlated with high levels of creativity in heterogeneous teams,¹⁰ participants often perceive themselves and their teams to be less creative in this setting. For example, one participant noted: It was difficult at times really, at times where people had conflicting ideas. So, if someone wanted to go in one direction for the video at least, someone else might have a completely different direction. It was kind of interesting when we tried to make a compromise on how everyone wanted to agree on structuring the video.

Through this active learning activity, students engaged in the ideational mode of creativity¹⁹ through questioning their own definitions of professionalism and others. This was achieved through the way in which this purposefully designed interdisciplinary group work required students to collectively agree on an artefact to examine, create a video and deliver a seminar presentation. Individual completion of a survey, reflection essay and an interview, however, was optional for students to participate.

The findings reinforce the intrinsic motivation hypothesis for creativity¹¹; students were keen and took charge of their own learnings and met the learning outcomes relating to professionalism in unique and creative ways. They engaged with resources outside of their typical learning settings and brought innovative ideas back to the classroom to teach their peers. This made the topic more engaging and interesting. All these tasks encouraged students to develop the skills of adaptability and versatility in learning and navigating through the various elements to complete the activity, paralleling a workplace environment.

In all, the study proposes that this creative and diverse group work has encouraged active and collaborative learning, and assisted students in conceptualising what professionalism might entail compared to a standard textbook definition.^10,12

This study gave students an opportunity to think broadly and metaphorically about professionalism. Concepts such as understanding diverse cultures and respecting different backgrounds were discussed. Most students found that having this freedom of interpretation allowed creative expression (mini-c creativity)¹⁸ of their thoughts and enabled them to be more open-minded. Though challenging, the students enjoyed this interdisciplinary group work as it enabled different opinions and perspectives to be heard and shared, which is analogous to a professional working environment (Pro-c creativity).¹⁸

Interdisciplinary communication skills and teamwork are key to enhancing patient care and safety.^29,30 Therefore, it would be beneficial to facilitate interdisciplinarity here by designing learning contexts that are informed by a connectedness learning approach.⁶ This should better prepare students for future workplace settings. In this group work, students were provided an opportunity to develop leadership skills, navigate group dynamics, and to ponder on the skillsets and viewpoints of students from other fields. This offered ‘active’ and realistic work-integrated learning experiences²² for both healthcare and non-healthcare students. Therefore, it is recommended that when designing the curriculum, academics should consider embedding explicitly designed work-integrated learning opportunities and environments to cultivate generic skills that facilitate creativity and diversity.

For the students, participation in this interdisciplinary project was unique. This was because students are otherwise siloed in their course due to insular organisational structures. There are no explicit formal opportunities within the current curriculum to engage and interact with students from other disciplines or tertiary levels for an extended duration. Students had to spend considerable time working on this group project in both physical and virtual environments. This included arranging to meet up face-to-face, collectively deciding on the artefact and filming the video together. Discussions then shifted online for final video editing and seminar preparation. As illustrated throughout the article, the three modes of creativity¹⁹ and connectedness learning approach⁶ are valuable.

Scheduling was problematic due to students having different timetables and juggling personal and work commitments. It would have been easier to manage if students were from the same discipline, though it might not imply being more productive or creative, since the perception of ‘feeling’ creative is different to ‘being’ creative.¹⁰ For future studies, academics need to agree on common times in each curriculum or limit the number of diverse group work to alleviate scheduling issues.

Although the current study has furthered the understanding of creativity and diversity in interdisciplinary group work and how these can be used to help students create knowledge of professionalism, there were several limitations that impacted these findings and implications of this study. The study was short-lived and involved a small student sample with unequal representation from each discipline and tertiary level, thus limiting generalisability. The interaction process could not be directly assessed, but rather was inferred based on data collection. Although the methods employed were established,³¹ a more explicit approach to assessing group experiences such as using a longitudinal audio diary and over a longer duration would be useful.

As the data collected are self-reported, future research might consider obtaining qualitative measures of creativity by utilising established instruments such as The Creative Person Scale³² or The Creative Self-Efficacy Scale.³³ Indices that relate to group conflict,³⁴ intrinsic motivation,³⁵ and perspective taking³⁶ would further enrich the findings.

The study did not assess whether the improved understanding of professionalism across different disciplines that was reported by participants was accurate (i.e. consistent with the relevant professional codes). It also did not assess whether there was any improvement in an (accurate) understanding of professionalism in their own discipline (for example, optometry).³⁷

Conclusion

Despite the limitations discussed, the results of this research make a meaningful contribution to current literature by empirically demonstrating that students from different disciplines could better construct their own understandings of professionalism when learning activities were performed in an authentically creative and diverse setting. It is hoped that this first piece of evidence will stimulate more studies on utilising group creativity and diversity in healthcare education.

Acknowledgments

This study was funded by the Faculty of Medicine, Dentistry and Health Sciences Learning and Teaching Initiative Seed Funding (2018). The authors express their deep appreciation to Mr. Paul Fletcher, Associate Professor Terry Mulhern and Dr. Brenda Ryan who were invaluable in subject recruitment.

Disclosure statement

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

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was funded by the Faculty of Medicine, Dentistry and Health Sciences Learning and Teaching Initiative Seed Funding (2018).