Browsing by Author "Monrouxe, L."

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Lapses in professionalism in Sri Lankan doctors and their impact on patient outcomes
(Sri Lanka Medical Association, 2015) Chandratilake, M.N.; Ho, M.; Rees, C.; Monrouxe, L.
INTRODUCTION AND OBJECTIVES: Today, the provision of optimal patient care and patient safety are the primary goals of healthcare delivery. Professionalism of doctors has an impact on achieving this goal. METHOD: This study was conducted as the Sri Lankan component of a collaborative qualitative research project with Taiwan on professionalism dilemmas faced by medical students. 64 Sri Lankan medical students described stories (narratives) of lapses in professionalism observed by them in clinical settings, at Focus Group Discussions (FGDs). The FGDs were audio-recorded and the transcripts were thematically analysed to explore the nature of lapses in professionalism and resulting patient outcomes. RESULTS: The students' narratives comprised lapses in communication, respect towards patients, accountability, integrity and probity, interprofessional relationships, compassion and care, acting within limitations, commitment to duty, managing conflicts of interests and ethical conduct in doctors in different grades. Such lapses have seemingly caused a variety of adverse patient outcomes: psychological distress, suboptimal treatment and even suicides and unwanted deaths. In almost all instances incidents were not reported, discussed or reflected upon to prevent future occurrences. Medical students appeared to suffer from high levels of moral distress due to observing such incidents but tended not to express their concerns due to their lowly status within the hierarchy. CONCLUSION: Lapses in professionalism in doctors appear to threaten patient safety and the provision of optimal patient care in Sri Lanka. The situation is unlikely to improve unless the hierarchical working culture changes to help students and doctors challenge such lapses.
A Scoping review of clinical reasoning research with Asian healthcare professionals
(Kluwer Academic Publishers, 2021) Lee, C.Y.; Jenq, C.C.; Chandratilake, M.; Chen, J.; Chen, M.M.; Nishigori, H.; Wajid, G.; Yang, P.H.; Yusoff, M.S.B.; Monrouxe, L.
ABSTRACT: Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment. KEYWORDS: Asia; Clinical reasoning; Health professions; Scoping review.
Understanding medical professionalism: insights into identity and cultural implications
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Monrouxe, L.
OBJECTIVES : 1. To understand the different ways in which medical professionalism is understood across country cultures 2. To understand what professional identity is and how this related to the different conceptualisations of professionalism 3. To consider how these issues impact upon the teaching and learning of professionalism and the extent to which this can ever be uniform across different country cultures. The term Medical Professionalism is said to signify a set of values, behaviours and relationships that underpin the role of a doctor. The concept of professional identity relates to the degree to which an individual has assimilated their professional role in terms of who they are, rather than just what they do. But these values, behaviours and relationships necessarily differ according to the cultural context in which we live. Drawing on her international programme of research in professionalism across the England, Wales, Australia, Taiwan and Sri Lanka, and the wider international literature around professionalism, Lynn will outline different ways of conceptualizing professionalism and how this can shed light onto the development of professional identities. This work ultimately leads her to ask questions around the education of professionalism and to question the one-size-fits-all approach so often adopted within medical education.