Teaching professionalism in the early years of a medical curriculum: a qualitative study

CONTEXT Despite the growing literature on professionalism in undergraduate medical curricula, few studies have examined its delivery. OBJECTIVES This study investigated tutors' and students' perspectives of the delivery of professionalism in the early years of Glasgow's learner-centred, problem-based learning (PBL), integrated medical curriculum. METHODS A qualitative approach was adopted involving semistructured interviews, on a 1 in 6 sample of tutors involved in teaching in the early curricular years, and 3 student focus groups. The findings were subjected to between-method triangulation. RESULTS Involvement in teaching raised students' and tutors' awareness of their professionalism. Learning activities promoting critical reflection were most effective. The integration of professionalism across the domains of Vocational Studies (VS) was important for learning; however, it was not well integrated with the PBL core. Integration was promoted by having the same tutor present throughout all VS sessions. Early patient contact experiences were found to be particularly important. The hidden curriculum provided both opportunities for, and threats to, learning. The small-group format provided a suitable environment for the examination of pre-existing perspectives. The portfolio was an effective learning tool, although its assessment should be formalised. CONCLUSIONS Reflection is integral to professional development. Early clinical contact is an important part of the process of socialisation, as it allows students to enter the community of practice that is the medical profession. Role models can contribute powerfully to students' learning and identity formation. As students move towards fuller participation, the clinical milieu should be controlled to maximise the influence of role models, and opportunities for guided reflection should be sustained.