Research On The Cultivation Of Medical Professionalism Through College English Teaching In Medical Colleges

Objective:Medical professionalism is one of the core competences that doctors must possess,and it is also the key to improve doctor-patient relationship.Since the 1990 s,more and more scholars have become interested in the cultivation of medical professionalism,and various disciplines in medical schools have begun gradually to explore in their own fields the elements that can be used to carry out professionalism education so as to form a joint effort to improve it.This study focused on the cultivation of medical professionalism in college English teaching and paid specific attention to the lower grade medical students.The research objectives lied in the development of a medical professionalism rating scale aiming at the lower grade medical students,the formulation of a systematic teaching scheme of medical professionalism in college English teaching and the evaluation of this teaching scheme.Methods: With reference to the questionnaire development theory proposed by Professor Robert F.De Vellis,this study firstly determined the Chinese physician professionalism as the conceptual framework for the development of Lower Grade Medical Student Professionalism Scale.The first version item pool of the scale was established through literature research method and the pre-established inclusion and exclusion criteria.Expert consultation method was used to preliminarily determine the items of the Lower Grade Medical Student Professionalism Scale.A questionnaire survey was conducted to test the first version scale.Using the data collected from the questionnaire investigation among lower grade medical students,more items were deleted through factor analysis.All the retained items formed the final version of Lower Grade Medical Student Professionalism Scale and its reliability and validity were tested through structural equation model and some other methods.Reflective writing was used to analyze the learning needs of lower grade medical students on professionalism.Firstly,based on the outcomes-based education theory,the learning objectives and themes were initially set up according to the milestone standards of professionalism cultivation under the “5+3” training model for clinical healthcare professionals.Secondly,through the analysis of college English text books and the applying of Delphi method,the teaching objectives,themes and the matching between the themes of college English teaching and medical professionalism cultivation were finally determined.In the end,directed by the teaching objectives and themes confirmed by the experts,the intervention process was designed with reference to the constructivist learning environment creation procedure.Quasi-experimental study was conducted to testify the effectiveness of the previously designed teaching scheme.The sample size of both experimental group and control group were estimated by PASS 15.0 software and the simple random sampling was selected to complete the sampling process.The previously designed intervention was carried out in the experimental group.Questionnaire investigation and reflective writing were used to complete the pre-test and post-test in the two groups.Both qualitative and quantitative analysis were applied to evaluate the effectiveness of the teaching scheme from four aspects,namely medical professionalism,empathy,English achievement and course satisfaction.Results: Through literature research and the preliminary screening,67 items were selected to construct the item pool of Lower Grade Medical Student Professionalism Scale.After expert consultation,12 items were deleted while 55 items were retained and formed the first version Lower Grade Medical Student Professionalism Scale.Using this scale as a survey tool,430 questionnaires were distributed to lower grade medical students in China Medical University,and 343 questionnaires were effectively collected.The statistical results showed that the KMO value of the first version Lower Grade Medical Student Professionalism Scale was 0.96,and the Bartlett spherical test result was P<0.01.Through multiple rounds of principal component analysis,23 items were retained while 32 items were deleted.The structural equation model(SEM)was used to perform confirmatory factor analysis(CFA)on the remaining items.After several rounds of CFA,14 items were retained and formed the final version of Lower Grade Medical Student Professionalism Scale.The Cronbach’s α value of the scale was 0.82,chi square degree of freedom ratio was 1.83,the root mean square error value was 0.05,the comparative fitness index was 0.98,the Tueker Lewis index was 0.97 and the standardized root mean square residual was 0.06.A total of 15 experts with senior titles were invited from the fields of clinical medicine,medical education and English education to attend the Delphi consultation.Their positive coefficient and average authoritative coefficient were 100% and 0.82 respectively,both of which were compliant with the relevant standards.In the second round of Delphi,the highest variation coefficient was 0.12 and was far less than 0.25,indicating that the experts’ opinions on each item were highly concentrated.The Kendall coordination coefficient was calculated to analyze the degree of consensus of experts.After the second round of consultation,the experts showed consistency in their opinions on teaching objectives,themes and the matching of themes between college English teaching and medical professionalism cultivation(P<0.01).Through two rounds of Delphi consultation,15 teaching objectives,12 professionalism cultivation themes and16 times of matching between English teaching and professionalism cultivation were determined.Leaded by the objectives and themes of professionalism cultivation,17 times of teaching procedures were designed according to the process of constructivist learning environment creation(one of the college English teaching themes matched two professionalism cultivation themes).In the quasi experiment,four English teaching classes were randomly selected based on sample size calculation and the student number of the English classes.Among them,two classes were randomly assigned to the experimental group and the other two were assigned to the control group.According to the principle of voluntary participation,there were finally 107 medical students in the experimental group and 92 medical students in the control group.The members of the two groups were all major in clinical medicine and were in the same grade.They took the same classes and had similar age composition and gender ratio.The baseline level of their English proficiency was similar because the English classes were randomly assigned on the basis of two English tests by the office of educational administration.Examined by the independent sample test,the two groups were similar in both the level of medical professionalism and empathy before the experiment.The results of paired sample test showed that the level of medical professionalism and empathy of the experimental group did not change before and after the experiment.However,according to the results of the paired sample test,the professionalism scores of the control group showed a significant downward trend(P<0.05),with a decrease of 1.39 mean score,indicating that the cultivation of medical professionalism in the English class helped to maintain the level of medical professionalism.The results of the independent sample t-test showed no significant difference in English scores between the two groups after experiment,indicating the cultivation of medical professionalism in college English teaching didn’t have negative effect on English study.The reflective writings of the experimental group before and after the experiment were analyzed using directed content analysis.Based on the statistics,10 out of the 11 categories determined according to Chinese medical professionalism were mentioned more frequently after the experiment,reaching 91% of the total categories.Before the experiment,8% of the medical students did not mention any of professionalism categories,while after the experiment,each medical student mentioned at least one of the categories.Before the experiment,only 2 medical students mentioned 4 or more categories of medical professionalism,accounting for 2% of the total number.After the experiment,20 medical students mentioned 4 or more professionalism categories,accounting for 24% of the total number.The numbers of the category reference of each medical student were counted.The results of rank sum test showed that there was a statistically significant difference in category reference before and after the experiment(P<0.001).The median of the category reference changed from 1 to 3.The response rate of the curriculum satisfaction questionnaire was 87%,all of which were valid ones.Based on the valid questionnaires,4% of medical students said they were satisfied with the course,and 96% of medical students said that they were very satisfied with the course.Meanwhile,in the responses to the open questions,many students expressed that they had leant knowledge related to medical professionalism,such as “doctor-patient communication”,“humanistic care”,“responsibility”,etc.Conclusions: This study developed Lower Grade Medical Student Professionalism Scale through six steps,including concept confirmation,item pool construction,medical student trial reading,expert consultation,population survey and statistical analysis.The reliability and validity results of the scale were satisfied,indicating that the scale can be used as a tool for the evaluation of medical professionalism among lower grade medical students.This study defined the teaching objectives and themes of medical professionalism in college English teaching and completed the matching of English teaching themes to the professionalism ones.All the objectives,themes and matchings were approved by experts through Delphi consultation,indicating the rationality and feasibility of adding medical professionalism cultivation in college English class.The effectiveness of medical professionalism training in college English teaching were tested through quasi-experimental study.The results showed that the teaching scheme can play a certain role in medical professionalism cultivation.The teaching scheme helped improve medical students’ mastery and understanding of medical professionalism and had no negative effect on students’ English proficiency.