Development and validation of an inventory (Dundee Barometer of Institutional Professionalism) to measure the professionalism culture of medical schools in the UK
Background: Professionalism, in today’s context, is a determinant of fitness-to-practise of doctors. Many professional and governing bodies around the world have emphasised the need for educating medical students explicitly about professionalism. In fostering professionalism, the institutional culture plays a concealed but vital role. Although the institutional professionalism culture should be explored and understood there was no suitable measure for use in the context of UK undergraduate medical education. The aim of this project was to develop a valid, reliable and practical measure of institutional professionalism culture. Methods and results: The project was conducted in two phases. In the first phase, forty six attributes of professionalism were identified in a literature review. These attributes were surveyed among a nationally representative quota sample of 954 members of the UK general public. They identified 44 attributes as important. With a principal component analysis, three facets to professionalism were identified: the relationship of doctors with patients (clinicianship) and co-workers (workmanship), and the behaviour of doctors in society (citizenship). By analysing the survey responses of 368 UK medical professionals using the Content Validity Index, 28 attributes were identified to represent each facet (clinicianship 10, workmanship 11, and citizenship 7). In the second phase, the 28 attributes were included in an online measure (Dundee Barometer of Institutional Professionalism) with a rating scale based on the Theory of Planned Behaviour (TPB), and field-tested among the faculty and students of the Dundee Medical School. Based on the TPB, questions on personal attitude, institutional expectation and achievability in relation to each attribute were included. The field-test received 212 responses. The measure demonstrated high internal consistencies at both measure and facet levels. It appeared that the professionalism culture in Dundee Medical School was patient-centred, teamwork-oriented and society oriented. A principal component analysis helped reduce the number of items to 15 with five attributes representing each facet. A generalisability study predicted a highly acceptable reliability with the 15 items. The reaction of respondents towards the measure was positive. Conclusions: The Dundee Barometer of Institutional Professionalism (DBIP) is the first quantitative measure of the culture of professionalism in UK medical schools. It was developed with the consensus of both professionals and the general public, and used a theory-based rating scale (hence high validity). It is shown to be reliable with 15 items. The DBIP is a practical measure as it is easy to administer and is acceptable to respondents. The construct validity of the DBIP and its ability to distinguish differences in professionalism culture are areas of future research.
Professionalism culture, measurement, assessment
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