MEDEV

School of Medical Sciences Education Development

Dental, nursing, pharmacy and physiotherapy students' professionalism dilemmas: A UK questionnaire survey

N.B. The information below is authored by the mini-project applicants, not by staff of MEDEV. This text represents the views and opinions of the mini-project team only, not those of the subject centre or its affiliates.

Principal investigator

Charlotte Rees,

Full list of project partners

Description

Aims/Objectives: The professional development of dental, nursing, pharmacy and physiotherapy students is paramount in healthcare education (The Chartered Society of Physiotherapy 2010, Nursing and Midwifery Council 2010, General Dental Council 2010, Royal Pharmaceutical Society 2009). Although students are taught good professional practice throughout their education, they are commonly exposed to professionalism dilemmas in work based learning, such as witnessing the physical and emotional maltreatment of patients (Erdil & Korkmaz 2009). Professionalism dilemmas cause students grave distress and can also impact negatively on their developing professional attitudes and behaviours (Kushner & Thomasma 2001). Although research has begun to explore students’ explanations of professionalism dilemmas within healthcare education (particularly nursing and dental education) these studies have methodological limitations: they are mostly single-site, and typically employ questionnaires not based on previously identified professionalism dilemmas experienced by healthcare students. We aim to address these limitations by exploring the prevalence of a range of professionalism dilemmas (identified in our earlier qualitative work i.e. studies 1 & 2) and the emotional impact that these dilemmas have on dental, nursing, pharmacy, and physiotherapy students across multiple sites in different countries (Wales, England, Scotland). Research questions include: (1) what is the prevalence of a range of professionalism dilemmas experienced by healthcare students across the UK? (2) What is the emotional impact of these professionalism dilemmas on healthcare students across the UK? (3) What (if any) relationships exist between the prevalence of different types of dilemmas, their emotional impact and other demographic (e.g. age, gender, ethnicity) and education-related variables (e.g. school, year of study)?

Methodology:
Design: From ongoing thematic analyses of our qualitative work (with medical students and other healthcare students), we have already developed an online questionnaire for medical students (as part of the ASME funded study i.e. study 3) aimed at capturing the prevalence and emotional impact of professionalism dilemmas (using the validated moral distress scale: Wiggleton et al. 2010). This questionnaire has been developed using the Bristol Online Survey (BOS) tool, which the co-investigator has received training on, and has been developed in accordance with best practice for web-based questionnaires (Umbach 2004). This questionnaire will serve as the basis from which a version for other healthcare students will be developed (using findings from our qualitative study funded by Health NG i.e. study 2). We will pilot the healthcare student version with 5 healthcare students from each of Dentistry, Nursing, Physiotherapy and Pharmacy at Dundee and Cardiff Universities (n=20 in total) and develop it based on feedback from these students. Links to the questionnaire will be circulated to a stratified random sample (approximately 25% of all schools with a range of curricula design) of dental, nursing, physiotherapy and pharmacy schools in the UK and all students in that stratified random sample enrolled in a programme of study for the academic year 2010-2011 will be invited to participate.

Recruitment:
There are 82 universities and colleges in the UK offering nursing degree courses, 26 offering pharmacy degree courses, 32 offering physiotherapy degree courses, and 29 offering dentistry degree courses (http://www.whatuni.com). It is outside the scope of this project to invite all students during the academic session 2010-2011 on each of these 169 courses, so instead we will invite a stratified (stratified by course and by country) random sample of approximately 25%, so 21 nursing courses, 7 pharmacy courses, 8 physiotherapy courses and 8 dentistry courses (total of 44 courses). As with our previous questionnaire survey (study 3), the Heads of each randomly selected School will be contacted and their permission sought to include students from their school in this questionnaire study. With ethical approval already in place from Cardiff University (for the medical student questionnaire i.e. study 3), we will seek approval from Dundee University for the current study, and then seek reciprocal approval from all other sites (see additional details below).

Participant recruitment methods:
All healthcare students enrolled on the randomly selected courses in the academic year 2010/2011 are eligible to participate in this study. The precise number of students will be unknown until after enrolment has taken place in September/October 2010. Healthcare students will be informed that participation in this questionnaire is voluntary and that anonymity will be assured in the pre-questionnaire circulated information. Similar to our recruitment strategy for study 3, through use of the selected schools’ emails systems, online learning environments (e.g. Blackboard, WebCT) and SMS messaging systems, the web-link for the questionnaire will be distributed. It is envisaged that directed advertising may also take place on social networking sites such as Facebook – and advertising will be directed at people who identify themselves as current healthcare students at the randomly selected sites in the UK. We also aim to raise awareness of the study through healthcare student organisations (e.g. British Dental Students Association) and via A4 notices pinned to student notice boards within Universities.

Data analysis:
The questionnaire(s) will collect a combination of quantitative and qualitative data. SPSS will be used to analyse quantitative data. Descriptive statistics (e.g. frequencies, percentages) will be employed to ascertain the demographic and education-related characteristics of the sample and prevalence rates of professionalism dilemmas, including their frequency and emotional impact. We will establish the distribution of all continuous variables and employ parametric and non-parametric statistics accordingly. Univariate and multivariate statistics will be employed to establish the relationship between demographic/education-related variables, professionalism dilemmas and emotional impact of dilemmas. Atlas-Ti will be employed to help with the qualitative data analysis, which will take the form of a thematic Framework analysis (Ritchie & Spencer 1994).

Activities:
Jan-Mar 2011: Identification of the sample, and securing ethics approval from all sites. Dundee will be approached first and then other sites will be asked for reciprocal approval.
April-Jun 2011: Launching questionnaire and conducting data collection (it is important that data collection occurs during this period so as to catch students near the end of their academic year). Alongside data collection, we will collect as many professionalism curricular documents as possible associated with the selected courses.
July-Sep 2011: Analysing the quantitative results from the questionnaire and dissemination of preliminary findings at a UK Conference (e.g. ASME 2011, Edinburgh, September, UK, or HEA Annual Conference).
Oct-Dec 2011: Analysing the qualitative results from the questionnaire. Journal writing to commence in December.
Jan 2012: Submission of article(s).

Value for money:
This project represents excellent value for money as most of the staff and overhead costs will be met by Dundee and Cardiff Universities, leaving only the RA cost to be provided by the grant itself. It is likely that the RA will be a healthcare student interested in developing their research career. Furthermore, the researchers have developed a body of work in this area and will not only draw on their subject expertise, they will also use the previously designed and piloted questionnaire (from Study 3) suitably developed according to the findings from their qualitative study (Study 2) and implement this according to the successful strategies for recruitment based on their experiences during Study 3. Thus we are able to execute an extremely complex and large-scale UK-wide study in a short timescale with an experienced team of researchers. Furthermore, with dissemination of the findings being included in the proposed book (in addition to journal articles and conferences), this research will have the potential to have a strong educational impact across the professions.

References:
The Chartered Society of Physiotherapy (2010) Professionalism. London: The Chartered Society of Physiotherapy.

Erdil F & Korkmaz F (2009) Ethical problems observed by student nurses. Nursing Ethics 16(5), 589-598.

General Dental Council (2010) Student Fitness to Practise. London: General Dental Council.

Kushner TK & Thomasma DC. (eds.) (2001) Ward ethics. Dilemmas for medical students and doctors in training. Cambridge, UK: Cambridge University Press.

Nursing and Midwifery Council (2010) The code: Standards of conduct, performance and ethics for nurses and midwives. London: Nursing and Midwifery Council.

Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In A. Bryman, RG Burgess (eds.), Analysing Qualitative Data. London: Routledge; 1994:173-194.

Royal Pharmaceutical Society (2009) Guidance on Students Fitness to Practise Procedures in Schools of Pharmacy. London: Royal Pharmaceutical Society.

Umbach PD. (2004) Web surveys: best practices. New Directions in Institutional Research, 121, 23-38.

Wiggleton CMD, Petruca EP, Loomis KMD, Tarpley JMD, Tarpley M, O'Gorman MLM & Miller BMD (2010) Medical Students' Experiences of Moral Distress: Development of a Web-Based Survey. Academic Medicine, 85, 111-117.

Aimed at

Our target audience is multi-layered: (1) healthcare (i.e. nursing, dentistry, physiotherapy and pharmacy) students, those responsible for their professionalism education and professionalism policy developers at the chosen sites; and (2) healthcare students, educators responsible for professionalism curricula and professionalism policy developers more widely (both nationally and internationally).

Outcomes

We anticipate the study findings informing recommendations for the development of professionalism curricula in dentistry, nursing, pharmacy and physiotherapy education. As with our previous research we anticipate that the qualitative and quantitative findings of this study could also be used as part of students’ professionalism curricula and as part of educators’ continuing professional development. We therefore expect healthcare students, their educators and professionalism policy developers to benefit from the findings of the proposed study. We anticipate numerous research outputs from this study including conference presentations, peer-reviewed journal articles and, along with the results of studies 1-3 outlined above, a book (see below for further details about dissemination).

Personal experience

Professor Charlotte Rees and Dr Lynn Monrouxe (formerly Knight) are experienced medical educators and principal investigators with backgrounds in social sciences and education research.

Charlotte Rees is currently Director of the Centre for Medical Education and Professor of Education Research across the College of Medicine, Dentistry and Nursing, University of Dundee. She has successfully managed various research projects as PI; including a British Academy funded study exploring stakeholders’ views about patient involvement in medical education (e.g. Rees et al. 2007) and an international questionnaire survey exploring medical students’ attitudes towards peer physical examination (e.g. Rees et al. 2009). She is also co-investigator for three different grants (British Academy, Health NG, and ASME) for our ongoing programme of research relating to healthcare students’ professionalism dilemmas (see below for more details on these projects). She was the founding academic lead for professionalism, communication, and human sciences at the Peninsula Medical School (2002-2005). She is the Deputy Editor of the leading medical education journal (i.e. Medical Education) and has published widely in international journals on topics relating to healthcare students’ professionalism.

Lynn Monrouxe is Director of Medical Education Research at the School of Medicine, Cardiff University. She has training in project management and has successfully completed a number of funded research projects as PI; most recently the British Academy funded qualitative research project on medical students’ explanations of behaviours during professionalism dilemma situations (e.g. Monrouxe et al. in press) (see details below). She is also PI for the ongoing Health NG and ASME projects (see details below). She has also been involved in the development and delivery of the professionalism curriculum at the Peninsula Medical School (2003-2007) and Cardiff School of Medicine (2007-2010). She has also published widely in international journals on topics relating to medical students’ professionalism.

Together, we have been working on a programme of research relating to healthcare students’ professionalism dilemma experiences, starting with a British Academy funded study (2007-2009) exploring medical students’ professionalism dilemmas at three schools in three different countries (England, Wales and Australia). More recently, we have been awarded two other grants, one from Health NG (2009-2010) and another from ASME (2010-2011) for two related projects respectively: (1) Exploring professionalism dilemmas in work based learning: personal incident narratives of dental, nursing, pharmacy and physiotherapy students from three Universities (Dundee, Cardiff and Plymouth); and (2) Medical students’ professionalism dilemmas: A UK questionnaire study (here, we are inviting all medical students in all 32 UK medical schools to participate in an online survey during the 2010-2011 academic session).

We give a brief synopsis of these three studies next and discuss how these three projects feed into the current request for funding.

Study 1: We have recently conducted a study examining medical students’ explanations of their own and others’ behaviours during professionalism dilemmas [British Academy LRG-45505]. Students across all years from three schools in England, Wales and Australia were invited to participate in either group or individual interviews (22 interviews, 32 groups, total n=200). 833 personal incident narratives of dilemma situations were collected. Thematic analysis revealed a broader range of situations than previously recognized including students witnessing superiors behaving unprofessionally, being placed in difficult situations (e.g. being asked to do an examination/procedure on an anaesthetised patient without their consent) and experiencing abuse or humiliation by superiors or patients. Students provided detailed descriptions of their behaviours within these situations and the factors that influenced those behaviours. Furthermore, the emotional impact of these dilemmas was apparent: students described a range of emotions from uncomfortable feelings during the dilemmas, to stronger feelings of stress and anxiety remaining with them after the dilemmas. This study has already resulted in 9 international conference presentations, one report to the General Medical Council in response to their consultation exercise for Tomorrow’s Doctors 2009, a book chapter, two papers submitted to peer-reviewed journals, and 2 invited keynote presentations at national and international conferences (see below). We anticipate a further 7 journal papers will be forthcoming from this data.

Study 2: We are in the throes of collecting personal incident narratives from nursing, dentistry, pharmacy and physiotherapy students from three Universities (Dundee, Cardiff and Plymouth) (Health NG grant 2010-2011). So far, we have conducted eight focus groups (1 with physiotherapy students, 4 with dental students, 2 with pharmacy students and 1 with nursing students) and 2 individual interviews with nursing students (giving a sample size of 57). We are planning to conduct another two focus groups at the start of the academic session 2010-2011 (one with nursing students and another with physiotherapy students) at the outstanding study site (Plymouth). Framework analysis of the transcribed data has already begun with three focus groups (one dentistry, one pharmacy and one physiotherapy) being analysed independently by two researchers. We decided to employ the coding framework developed for study 1 but to develop this coding framework as necessary throughout the coding of data for study 2. Preliminary analyses indicate that we have well over 100 narratives from healthcare students and that these students experience similar professionalism dilemmas to those identified by medical students in study 1. Also similar to medical students, professionalism dilemmas experienced by healthcare students appear to have profound negative emotional impacts on the students. However, there does appear to be some discipline-specific dilemmas. For example, consent dilemmas (such as students conducting intimate examinations on patients without valid consent)—a type of dilemma commonly articulated by medical students in study 1, is never cited as a dilemma by other healthcare students in study 2 (although admittedly we have not yet completed data collection for this study). Furthermore, dentistry students cite dilemmas not commonly cited by other healthcare students, probably related to the level of clinical responsibility they have as students, such as making fairly serious clinical mistakes with patients and subsequently covering up their mistakes to patients and supervisors. We have submitted our mid-project report to the HEA for this study and anticipate finishing this project on time and on budget. We also anticipate writing numerous articles from this study.

Study 3: We were awarded a small grant from ASME in Spring 2010 to collect data from all medical students at all UK schools using an online questionnaire developed from the results of study 1. This study aims to establish the prevalence of the different types of professionalism dilemmas identified in study 1 across the UK and to determine the emotional impact of these dilemmas on students. We have so far designed the survey on the basis of study 1 findings and have piloted this prior to applying for ethics approval at Cardiff University. We have received ethics approval from Cardiff University and we have conducted a second pilot in order to develop the questionnaire further. Now that we have Cardiff ethics approval, we have approached the ethics committees of all remaining medical schools and await their response. We aim to collect data from medical students during Jan-May 2011. We anticipate writing numerous articles from this work.

Study 4: The study that we are proposing in the current application will build on the previous 3 studies and complete the jigsaw for this programme of research (see below for details).

Joint Output: We are currently writing a book proposal for Routledge to disseminate the findings from this programme of work educationally. The book is aimed at developing healthcare students’ understanding of the ethical and psychosocial issues underpinning their professionalism dilemmas in order to empower them to become patient-centred professional practitioners. Therefore the success of the current study proposal will strengthen this process by enabling us to include prevalence and emotional impact data from nursing, dentistry, pharmacy and physiotherapy students as well as from medical students (study 3).

References relating to programme (in chronological order)
Knight LV & Rees CE (2008) Medical students’ explanations of their own and others’ behaviours within professionalism dilemma situations: implications for the assessment of professionalism. Presented at the ASME workshop ‘Medical students: professional behaviour and fitness to practise’, 5th June, RIBA, London.

Knight LV & Rees CE (2008) Medical students’ professionalism dilemma situations: The whats and hows of behaviour explanations. Presented at AMEE 2008, 30th August – 3rd September, Prague, Czech Republic.

Rees-Davies L, Knight LV & Rees CE (2008) ‘It doesn’t matter if you kill the patients ha ha:’ Medical students’ explanations of behaviour of professional dilemma situations during overseas electives. Presented at “Quality Counts: Developing Theory and Practice in Medical Education Research”, 18th November 2008, Cardiff University, UK.

Rees CE, Monrouxe LV & Rees-Davies L (2009) “He couldn’t move his legs ha ha ha ha ha”: The function of laughter in medical students’ accounts of professionalism dilemmas. Presented at the ASME Annual Scientific Meeting 2009, 15-17th July, The Royal College of Physicians, Edinburgh, UK.

Monrouxe LV, Rees CE, Rees-Davies L & Sweeney K (2009) “Oh I’d better wash my hands because you’re there”: effects of medical students’ acts of resistance during medical workplace learning encounters. Presented at the ASME Annual Scientific Meeting 2009, 15-17th July, The Royal College of Physicians, Edinburgh, UK.

Monrouxe LV, Neve H, Rees CE, Sweeney K & Rees-Davies L (2009) Medical students’ explanations of professionalism dilemmas experienced whilst overseas: Who do I think I am? A preliminary report for the Tomorrow’s Doctors consultation in the UK. Presented to the General Medical Council, London.

Monrouxe LV, Rees CE, Rees-Davies L & Sweeney K (2009) “Come here. I want you to feel a normal rectum. Do it.”: medical students’ explanations of their behaviours during consent dilemmas involving intimate examinations. Paper presented at the 39th Annual Meeting Association for the Behavioral Sciences and Medical Education. Santa Fe, New Mexico, 8th-10th October 2009.

Monrouxe LV & Rees CE (2009) “I’ve got one! I’ve got one! When I was…” Medical students sharing narratives of professionalism dilemmas. Presented at ASME Researching Medical Education Conference 2009, 16th November 2009, RIBA, London, UK.

Rees C, Monrouxe LV & Rees-Davies L (in press) “Oh my God uh uh uh”: Laughter for coping in medical students’ personal incident narratives of professionalism dilemmas. In: CR Figley, P Huggard & C Rees, First do no self-harm: Understanding and promoting physician stress resilience. New York: Oxford University Press; forthcoming.

Monrouxe LV, Rees CE, Hu W (in press) Differences in students’ discourses of medical professionalism: acting, representing, becoming. Medical Education.

Rees CE, Monrouxe LV (under review) Medical students learning intimate examinations without valid consent: an international study. Medical Education.

Rees CE & Monrouxe LV (2010) “They just had a queue of medical students doing a rectal examination”: Analysing medical students’ narratives of intimate examination dilemmas involving inadequate patient consent. Presented at the Annual Scientific Meeting of AMEE, 4-8th September 2010, Glasgow, UK.

Monrouxe LV & Rees CE (2010) Medical students’ personal incident narratives of professionalism dilemma situations: An international study. Presented at the Annual Scientific Meeting of AMEE, 4-8th September 2010, Glasgow, UK.

Rees CE (2010) Invited keynote presentation: Exploring medical students’ professionalism dilemmas in general practice. Presented at the Teaching and Learning Event (TALE), 14th September 2010, University of Glasgow, UK.

Rees CE (2011) Invited keynote presentation: Learning clinical skills in the workplace: Creating professionalism dilemmas for healthcare students? To be presented at the Fourth International Clinical Skills Conference, 22-25th May 2011, Monash Prato Centre, Prato, Italy.

Other references
Rees CE, Knight LV & Wilkinson CE (2007) “Doctors being up there and we being down here”: a metaphorical analysis of talk about student/doctor-patient relationships. Social Science & Medicine 65(4), 725-737.

Rees CE, Wearn AM, Vnuk AK & Sato TJ (2009) Medical students’ attitudes towards peer physical examination: findings from an international cross-sectional and longitudinal study. Advances in Health Sciences Education 14, 103-121.

Ethical approval

Ethical approval will be necessary to carry out this project. We will initially seek approval from the Dundee ethics committee. Upon successful application, we will contact the ethics committees at other participating Universities in order to secure their approval. We already have ethics approval for our online questionnaire with medical students (from Cardiff University) and have been informed by various other medical schools that they will give us reciprocal approval on the basis of approval from Cardiff. We anticipate the same happening with the current proposed study with other healthcare students. Based on work undertaken from our previous online questionnaire we anticipate securing all the necessary ethics approvals during Jan-March 2011.

Other work

Although there is a growing body of literature exploring the professionalism dilemmas experienced by medical students (e.g. Kushner & Thomasma 2001), there is a relative dearth of research examining dilemmas encountered by other healthcare students.
Research has begun to explore such dilemmas in nursing and dentistry in particular, with some notable similarities and differences in comparison with medical students. Like medical students, nursing students have been found to witness the physical and psychological maltreatment of patients, ignoring patient’s privacy, and violations of confidentiality and consent by nurses and doctors (Cameron et al. 2001; Erdil & Korkmaz 2009; Killen 2002; Park et al. 2003). However, the nursing literature tends to lay greater emphasis on the disempowerment of nursing students (and nurses) within the medical hierarchy and the relationship between that disempowerment and professionalism dilemmas (Killen 2002; Peter et al. 2004). Such conflicts in hierarchy have also been reported by hospital pharmacists when discussing their interactions with doctors, such as their difficulties trying to challenge inappropriate prescriptions by doctors (Kalvemark et al. 2004). Like medical students, dental students reported professionalism dilemmas related to conflict between clinicians, clinicians not following standards of care, belittling patients, and capacity to consent dilemmas (Modifi et al. 2003; Sharp et al. 2005; Wilson & Ayers 2004). However, dental students also report professionalism dilemmas related to patient’s (in)ability to pay, and dilemmas around treating friends and family (Modifi et al. 2003; Sharp et al. 2005; Wilson & Ayers 2004). Finally, physiotherapists have reported confidentiality dilemmas due to curtained areas, lack of facilities, departmental layouts, lack of privacy, time pressures, computerised notes and multidisciplinary team working (Cross & Sim 2000).
While studies are beginning to explore the professionalism dilemmas encountered by healthcare students, they tend to employ samples from single sites using questionnaire surveys not based on previously identified professionalism dilemmas of those students (e.g. Erdil & Korkmaz 2009, Killen 2002).
We are currently conducting a Health NG funded study to explore the personal incident narratives of nursing, dental, physiotherapy and pharmacy students at three UK schools (Dundee, Scotland, Cardiff, Wales; Plymouth, England—study 2 as described above). While this data will provide a rich picture regarding the breadth of professionalism dilemmas encountered by healthcare students, it will fail to determine the prevalence of professionalism dilemmas and their emotional impact in these healthcare students across the UK. Therefore, the current study aims to explore the prevalence of professionalism dilemmas and their emotional impact on healthcare students across the UK using an online survey based on the findings of our qualitative studies with medical and other healthcare students (i.e. studies 1 & 2).
References
Cameron ME, Schaffer M & Park H-A (2001) Nursing students’ experience of ethical problems and use of ethical decision-making models. Nursing Ethics 8(5), 432-447.

Cross S & Sim J (2000) Confidentiality within physiotherapy: perceptions and attitudes of clinical practitioners. Journal of Medical Ethics 26, 447-453.

Erdil F & Korkmaz F (2009) Ethical problems observed by student nurses. Nursing Ethics 16(5), 589-598.

Kalvemark S, Hoglund AT, Hansson MG, Westerholm P & Arnetz B (2004) Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science & Medicine 58, 1075-1084.

Killen AR (2002) Stories from the operating room: moral dilemmas for nurses. Nursing Ethics 9(4), 405-415.

Kushner TK & Thomasma DC. (eds.) (2001) Ward ethics. Dilemmas for medical students and doctors in training. Cambridge, UK: Cambridge University Press.

Mofidi M, Strauss R, Pitner LL & Sandler ES (2003) Dental students’ reflections on their community-based experienced: the use of critical incidents. Journal of Dental Education 67(5), 515-523.

Park H-A, Cameron ME, Han S-S, Ahn S-H, Oh H-S & Kim K-U (2003) Korean nursing students’ ethical problems and ethical decision making. Nursing Ethics 10(6), 638-653.

Peter E, Lunardi VL & Macfarlane A (2004) Nursing resistance as ethical action: literature review. Journal of Advanced nursing 46(4), 403-416.

Sharp HM, Kuthy RA & Heller KE (2005) Ethical dilemmas reported by fourth-year dental students. Journal of Dental Education 69(10), 1116-1122.

Wilson HJ & Ayers KMS (2004) Using significant event analysis in dental and medical education. Journal of Dental Education 68(4), 446-435.

Outcomes

Student involvement

We have already involved three students as research assistants in our programme of research relating to professionalism dilemmas: Stephanie Wells (a medical student from Cardiff University), Hannah Linford (a medical student from Peninsula Medical School) and Uma Madav (a dentistry student from Cardiff University) and they have each contributed to the development of the current application.
We anticipate employing Stephanie/Hannah/Uma as the research assistant(s). Stephanie, for example, is a new researcher who joined us in Spring 2010 as a Research Assistant on our ASME funded study investigating UK medical students’ professionalism dilemmas using an online questionnaire. Her main duties involved obtaining ethical approval, conducting a literature search, and collating all professionalism curricular documents from participating schools. Since joining us she has begun to develop research skills and working on this project will enable her to develop further by taking a more active role e.g. in the preliminary analysis of data.
Furthermore, we are anticipating thousands of students completing the online survey. The process of completing the survey will encourage students to reflect on professionalism dilemmas they have experienced during their training in a structured way, particularly the final question which asks students to write down details of their most memorable professionalism dilemma. The BOS allows students to print out their answers to each questionnaire item including their own most memorable narrative. Students can include these answers in their portfolio and discuss their professionalism dilemmas with their peers and professionalism mentors. Therefore, participating in the study by completing the online survey is likely to strengthen student engagement in their own professionalism learning.

Impact dissemination