Professionalism – thepatients’ perspectiveKatherine Walton, Fourth Year Medical Student, Newcastle University, Newcastle uponTyne, UK

Wiggins M, Coker K, Hick E. Patients’

perceptions of professionalism:

Implications for residency education.

Med Educ 2009; 43: 28–33.

Communication skills andcompassion have been high-lighted as the most importantaspects of doctors’ professional-ism in a recent patient survey.

Professionalism incorporatesmany components, and is anessential part of medical training.The literature, however, focusespredominantly on health careprofessionals’ views of the sub-ject, and so researchers set out toexplore professionalism from thepatients’ perspective.

The study aimed to identifywhich characteristics of a doctormost closely represent patients’views of professionalism, and todetermine whether patientsattending an ophthalmologyclinic perceived the resident phy-sician to exhibit these character-istics. A further aim of the studywas to explore the effect of theresident physician’s professionalbehaviour on the patient’s desireto see the attending senior phy-sician afterwards. The authorshypothesised that a residentphysician displaying professionalbehaviour might appear moreclinically competent, resulting ina decreased need for seniorphysician involvement.

A questionnaire was distributedto 148 patients attending an oph-thalmology clinic over a 3-monthperiod. The four-question surveyencompassed the following points.

1. The characteristics that pa-tients perceive as beingimportant with regards toprofessionalism. Respondentswere asked to rate a pre-determined list of professionalqualities, which were chosenby the authors, and approvedby an eight-person panelcomposed of physicians andother medical educators. Athree-item scale of ‘veryimportant’, ‘important’ and‘less important’ was used.

Communicationskills andcompassionhave beenhighlighted asthe mostimportantaspects ofdoctors’professionalism

Digest

� Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 59–62 59

2. The single characteristic listedthat was perceived to be mostimportant to the patient.

3. Whether resident physicians atthe ophthalmology clinic dis-played these characteristics.

4. Whether the patient still feltthe need to see a seniorphysician afterwards.

A total of 133 questionnaireswere returned, with a 90 per centresponse rate. The principal find-ings were as follows.

• Communications skills, such as‘pays attention to my con-cerns’ and ‘speaks in terms Ican understand’, were thecharacteristics of profession-

alism rated as ‘very important’most frequently.

• Showing compassion and notappearing rushed were alsojudged to be more importantthan characteristics such as‘neat appearance’ and ‘washeshands in front of me’.

• ‘Pays attention to my con-cerns’ was rated the single,most important characteristic(chosen by 63% of therespondents), although somerespondents misinterpretedthe question, and selectedmore than one item.

• Over 80 per cent of patientsacknowledged that the resi-

dent physician in the oph-thalmology clinic possessedall of the listed characteristicsof professionalism, but83 per cent stated that seeingthe senior physician after-wards was still important.

The majority of items wererated as ‘very important’ or‘important’ by respondents. Froman educational standpoint, it isreassuring that the views of thedeliverers of medical educationare concordant with those ofpatients, and, at least withinthis centre, students are beingtaught skills that meet patientexpectations. However, furthervaluable information could havebeen obtained had respondentsbeen offered a free text box toenter any additional characteris-tics of professionalism that theybelieved to be important. Thestudy gives no details aboutparticipant demographics, suchas ethnicity and social class, andtherefore the results may not begeneralisable to other popula-tions. That the study was con-ducted with a set of patientsfrom only one speciality, to-gether with the relatively smallsample size, are furtherlimitations recognised by theauthors.

This is the age of the con-sumer, and studies that provide ascientific basis for measuring thepatient perspective on profes-sionalism are both long overdue,and to be welcomed.

It is proposed that the re-sults of this study can be usedto help prioritise residencyteaching in this area. There willbe much merit in repeating thisexercise in a well-documentedpopulation in the UK to informthe development of UK trainingprogrammes.

Studies thatprovide a

scientific basisfor measuring

the patientperspective on

profession-alism are bothlong overdue

60 � Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 59–62