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Assessment, Medical professionalism, Medical students, Faculty, IntroductionMedical professionalism is one of the core competencies of physicians ( 1, , 2, ). It, along with the expectation of professional competency, is the relationship of trust between the physicians and society ( 3, - 6, ). Professionalism has been the focus of attention in medical education during the last two decades along with its challenges of teaching, learning and assessing ( 7, ). The attitude of young medical graduates is a source of concern for all medical educationists. This highlights the need for formal teaching and assessment of medical professionalism ( 8, ). The conduct of doctors rather than their competency is the reason for most of the complaints against doctors ( 8, , 9, ). It is suggested that professionalism should be a part of training of medical students in order to minimize any form of professional misconduct in future practice ( 9, - 11, ). Such trainings are often an implicit part of curricula ( 12, , 13, ). However, the emphasis on formal training of medical professionalism to achieve it as a competency has only intensified recently ( 14, , 15, ). To achieve this goal, different teaching modalities are being used for formal teaching including case scenarios, reflection, class lectures, small group discussions, bedside teaching and use of videos, etc. ( 15, - 17, ). The assessment of medical professionalism is, however, a challenge. There is no single accepted tool of assessment. Various assessment tools used are self-evaluation, practical examinations, structured exams, incident reporting and developing portfolios ( 6, , 10, , 18, ). The self-assessment tools provide an insight about the individuals&,rsquo perception of different domains of medical professionalism. It can be used to identify the strengths and weaknesses of individuals.The medical students learn professionalism throughout their undergraduate years both formally and informally. As freshmen, medical students learn the theoretical concepts and philosophy of professional conduct. The faculty of the medical school also acts as their role models. The clinical placements play a significant role in learning professionalism from the faculty ( 15, ). In order to assess various traits of professionalism in the students and faculty of SMDC, we decided to use a self-assessment tool. The Learner&,rsquo s Attitude of Medical Professionalism Scale (LAMPS) devised and validated by M Al-Eraki in 2013 was used ( 19, ). The students of the First and Final Year MBBS and faculty members were assessed and compared. The purpose of this study was to know the perceived gaps in various domains of medical professionalism. This would be helpful in modifying the curriculum of the medical college, if required. MethodsSettingsThe study was conducted at Shalamar Medical and Dental College, Lahore from June 2018 to Dec 2018 after approval from the Institutional Review Board (IRB) of SMDC.SubjectsFirst Year and Final Year students of SMDC at the end of their academic year were enrolled in the study, using non-probability convenience sampling. Sample size was calculated by the formula presented by Cochran and David. By using a questionnaire response in five-point scale, a minimum sample size of 119 was calculated, using a level of significance of 5%and a margin of error of 3%. In view of unevenness of the study and expected nonresponse, 200 subjects were recruited to achieve the research objectives ( 20, ). LAMPS questionnaire was distributed among 100 students from each class who agreed to participate in the research voluntarily. Each class was approached by the researchers when the students were in their lecture halls, just after finishing their lectures. They were all informed about the purpose of the study and their voluntariness to participation in the study. They were handed questionnaires and consent forms. Only the students willing to participate in the study returned the anonymously filled out questionnaires. A total of 50 faculty members from Basic and Clinical Sciences agreed to participate. The students and faculty members were briefed about the research.MethodsThis is a cross-sectional survey. Non-probability convenience sampling was used. Sample size was calculated by applying the formula of Cochran and David. The level of significance was kept at 5%, and the margin of error was 3 percent ( 20, ). LAMPS was used as the study instrument after taking permission from Al-Eraki who devised and validated it in 2003 in the Arabian context ( 19, ). This is a self-assessed perception of the attitude in different domains of professionalism. Duty Accountability, Excellence/ Autonomy, Honor/Integrity, Altruism, and Respect were assessed by 28 items. Seven items were for Duty/Accountability, 6 items for Excellence/Autonomy and 5 items each for Honor/Integrity, Altruism and Respect. In each item, the participants were asked about their behavioral response to a given scenario. The responses were on a Likert Scale where [1] represented strong disagreement and [5] represented strong agreement. However, the reverse was true in the case of negative statements where [1] represented strong agreement and [5] represented strong disagreement. The overall reliability of LAMPS by Cronbach&,rsquo s alpha was 0.7. The reliability of individual domains, i.e. Respect, Excellence/Autonomy, Altruism, Duty/Accountability and Honor/Integrity was 0.57, 0.48, 0.42, 0.57 and 0.43, respectively. A reliability ranging from 0.3 to 0.6 was considered to be moderate. LAMPS has been derived from the definition of professionalism given by American Board of Internal Medicine. Its content validity was confirmed by 32 experts in medical education after piloting with more than 300 respondants ( 19, ). The instrument was used in its original form and English language. The students were given the questionnaire along with the consent form in their classrooms. They were given half an hour to respond, and then the forms were collected. The faculty were given two weeks to respond. Inclusion CriteriaFirst and Final Year MBBS students and faculty members who consented to participate were included in the study.Exclusion CriteriaIncomplete questionnaires were excluded from the study.Statistical AnalysisThe data were analyzed using SPSS 24. The means for each domain were calculated and compared by using t-test. The comparison was made between the students of First Year and Final Year, and between the students of Final Year and Faculty. P value less than 0.05 was considered as significant.Ethical ConsiderationThe study proposal was approved by an OHRP (Office of human Research Protection) registered Institutional review Board of Shalamar Medical &,amp Dental College, Lahore (SMDC-IRB-068, dated on 7th June, 2018). The study was initiated after the issuance if approved letter. The data was anonymously collected and was kept confidential by the researcher.Results204 study participants in this study included 166 students and 38 faculty members. Out of 166 students who completed the survey, 88 were from the First year and 78 from the Final year groups. Out of 50 faculty members, 38 of them completely filled the survey. Hence, the response rate was 88%, 78% and 76% for the first year, final year and faculty, respectively. The students and faculty members, who had not filled the questionnaire completely, were excluded from the study. The domains of professionalism that were assessed included Duty/Accountability, Excellence/Autonomy, Honor/ Integrity, Altruism and Respect. Table 1, shows the demographic data of the participants, including their mean age and gender distribution. Table 2, shows the comparison of different domains of professionalism between the First year and Final year. Honor/Integrity was found to be the most frequently selected attitude of medical professionalism, whereas Excellence/Autonomy remained the least selected domain by the First year and Final year MBBS students. The p values of the domains of Excellence/Autonomy and Altruism were found to be statistically significant, whereas p values of the rest of the domains were not statistically significant. Table 3, shows comparison of different domains of professionalism between the Final year students and faculty. The faculty of SMDC also rated Honor/Integrity as the most frequently valued attribute of medical professionalism. Excellence/Autonomy remained the least frequently valued domain by the Final year MBBS students as well as the faculty members. The p values of the domains of Excellence/Autonomy and Honor/Integrity were found to be statistically significant, whereas those of the rest of the domains were not statistically significant. The comparison of the means of domains of professionalism among the First year, Final year students and faculty of SMDC by using LAMPS is shown in Figure 1,. Honor/Integrity was the most frequently valued trait and Excellence/Autonomy was the lowest scored domain of medical professionalism by all three groups. Honor/Integrity was the domain with the highest score in the faculty and lowest among the first year students. The reverse was found to be true for Excellence/Autonomy, whereas the rest of the domains did not show variability. First Year (n=88)Final Year (n=78)Faculty (n=38)Age (Average)18.9 24.19 51.3 Males41(47.10%)36(47%)22(58%)Females*,47(52.9%)42(53%)16(42%)*SMDC, Shalamar Medical &,amp Dental College |