Exploring Concepts of Professionalism in Surgical Training in the University of Nairobi

Abstract

Background Medical professionalism defines the relationship between doctors, patients, and society. As a social construct, public oaths affirm public trust and demonstrate a commitment to values beyond a physician’s personal interest. Its complex nature makes its conceptualisation and challenges unique across generations and cultures. Objective This study sought to explore the concepts of professionalism in surgical training within the Kenyan cultural setting, its challenges, how it has been taught up to now, as well as future methods to enable it to be inculcated more effectively. Methodology A sequential mixed methods study was conducted among clinicians, students, and patients at Kenyatta National Hospital in the surgical wards from 1st March 2014 to 31st December 2014. The first phase of the study involved Focus Group Discussions (FGD) of 10–12 persons and individual in-depth interviews with senior faculty members and patients. A grounded theory method was used to collect and analyse the perceptions of participants. These views were then coded using Atlas 5.2 (Scientific Software Development GmbH, Berlin 2002), allowing the development of a questionnaire that provided the survey tool for the second phase of the study. For the questionnaire, response options utilized a 4-point Likert scale with a range from ‘strongly agree’ to ‘strongly disagree’. Factor analysis was used to analyse the responses to the survey. Cronbach's α determined internal reliability. Results Sixteen (16) FGDs were held with 204 health care workers and students, as well as 18 in-depth interviews with ten senior faculty members and eight patients. A total of 188 participants filled the questionnaire from the 250 that were distributed to consenting participants. The predominant concept of professionalism held by the both the interviews and survey participants was respect which they reported was most commonly taught through apprenticeship, with 75.4% in the survey strongly agreeing. The main challenges reported were a lack of moral character. In addition, both phases suggested further ways to inculcate professionalism effectively through the transformation of character and an enabling environment, with 75% strongly agreeing that transforming mentorship was a more effective way of achieving the objective. vi Conclusion and recommendations “Respect” as a cultural value is an important aspect of professionalism. The challenge is how it should be inculcated and sustained. Current teaching methods may be inadequate, and the study suggests new ways to foster professionalism including transformation of character and an enabling environment.