Monrouxe Lynn V, Chandratilake Madawa, Gosselin Katherine, Rees Charlotte E, Ho Ming-Jung
Chang Gung Medical Education Research Center (CG-MERC), Chang Gung Memorial Hospital, Linkou, Taiwan.
Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
Med Educ. 2017 Jul;51(7):718-731. doi: 10.1111/medu.13291. Epub 2017 Apr 25.
The definition of medical professionalism poses a challenge to global medical educators. This is especially pronounced in settings where professionalism frameworks developed in the west are transferred into different cultures. Building upon our previous study across Western contexts, we examine Taiwanese and Sri Lankan medical students' conceptualisations of professionalism in terms of what professionalism comprises (i.e. dimensions) and how it is linguistically framed (i.e. discourses).
A qualitative group interview study was undertaken comprising 26 group interviews with 135 participants from one Taiwanese (n = 64; Years 4-7) and one Sri Lankan medical school (n = 71; Years 2-5). Through thematic framework analysis we examined the data for explicit dimensions of professionalism. Through discourse analysis we identified how participants constructed professionalism linguistically (discourses).
Thirteen common dimensions across Taiwanese and Sri Lankan talk were identified, with the dimensions (contextual, integration and internalised self) being identified only in Sri Lankan data. Professionalism as knowledge and patient-centredness were dominant dimensions in Taiwan; in Sri Lanka, attributes of the individual and rules were dominant dimensions. Participants in both countries used four types of discourses previously identified in the literature. Individual and interpersonal discourses were dominant in Taiwanese talk; the collective discourse was dominant in Sri Lankan talk. Findings were compared with our previous data collected in Western contexts.
Despite some overlap in the dimensions and discourses identified across both this and Western studies, Taiwanese and Sri Lankan students' dominant dimensions and discourses were distinct. We therefore encourage global medical educators to look beyond a one-size-fits-all approach to professionalism, and to recognise the significance of context and culture in conceptualisations of professionalism.
医学专业精神的定义给全球医学教育工作者带来了挑战。在西方制定的专业精神框架被移植到不同文化背景的情况下，这种挑战尤为明显。基于我们之前在西方背景下的研究，我们从专业精神的构成要素（即维度）以及其语言表述方式（即话语）两个方面，研究了台湾和斯里兰卡医学生对专业精神的概念理解。
开展了一项定性小组访谈研究，对来自一所台湾医学院（n = 64；4至7年级）和一所斯里兰卡医学院（n = 71；2至5年级）的135名参与者进行了26次小组访谈。通过主题框架分析，我们研究了数据中专业精神的明确维度。通过话语分析，我们确定了参与者如何在语言上构建专业精神（话语）。
在台湾和斯里兰卡的访谈中确定了13个共同维度，其中“情境、整合和内化自我”这几个维度仅在斯里兰卡的数据中出现。在台湾，专业精神作为知识和以患者为中心是主导维度；在斯里兰卡，个人特质和规则是主导维度。两个国家的参与者都使用了文献中先前确定的四种话语类型。在台湾的访谈中，个人和人际话语占主导；在斯里兰卡的访谈中，集体话语占主导。研究结果与我们之前在西方背景下收集的数据进行了比较。
尽管本研究与西方研究在维度和话语方面存在一些重叠，但台湾和斯里兰卡学生的主导维度和话语是不同的。因此，我们鼓励全球医学教育工作者摒弃一刀切的专业精神培养方法，认识到背景和文化在专业精神概念理解中的重要性。
