Background: The care of clients with complex psychosocial problems involves diverse frontline professionals such as general practitioners, psychiatric nurses, police officers, social support... Show moreBackground: The care of clients with complex psychosocial problems involves diverse frontline professionals such as general practitioners, psychiatric nurses, police officers, social support consultants and debt counselors. As these professionals have different professional backgrounds and work in different organizations, their health conceptions, or beliefs about what constitutes health and how this should be pursued, may also differ. Having an understanding of various frontline professionals' health conceptions is relevant, as these may affect interprofessional collaboration in their work with clients with psychosocial problems. Objective: To understand various frontline professionals' health conceptions. Design: Inductive qualitative approach. Setting: The Hague, the Netherlands. Participants: Various frontline professionals from social welfare, general healthcare and mental healthcare, working with clients with complex psychosocial problems. Methods: Between September 2020 and April 2021, 23 in-depth semi-structured interviews were conducted with frontline professionals in social welfare, general healthcare and mental healthcare. Based on these interviews, this paper analyzes frontline professionals' health conceptions. After transcription, all interviews were imported into ATLAS.ti for analysis. An iterative process of thematic analysis was used to identify health conception dimensions. Results: The paper found that frontline professionals' health conceptions differ in three main aspects: 1) health definitions, 2) alignment with clients and 3) contextualization of clients' health. Conclusions: The main implication of this research is that this inductive analysis of health conceptions provides a first building block in theorizing frontline professionals' health promotion practices. Tweetable abstract: Knowing about professional's health conceptions gives insight into how health is understood and how good health can best be achieved, which is important in caring for vulnerable clients. Show less
Aimed to gain insight into patients’ expectations regarding the professionalism of GPs, we first studied unsolicited patient complaints. It appeared that a substantial proportion of unsolicited... Show moreAimed to gain insight into patients’ expectations regarding the professionalism of GPs, we first studied unsolicited patient complaints. It appeared that a substantial proportion of unsolicited complaints concern professionalism issues. This dissertation provides insight into how patients experience unprofessional behaviour of physicians.Further, it provides educators with appropriate language to describe the unprofessional behaviour of residents, which matches that of the 4 I’s model. This language can contribute to the early identification of professionalism issues and the remediation of lapses in professionalism.This dissertation also provides insights into the PIF of GP residents from the perspectives of both supervisors and residents. According to residents, identity formation occurs primarily in the workplace as they move from doing the work of to becoming a GP and negotiate perceived norms. Residents feel that a tapestry of interrelated influencing factors – most prominently clinical experiences, clinical supervisors, and self-assessments – which changes over time, is felt to exert its influence predominantly in the workplace. Their supervisors have an image of the professional identity they are supporting and work toward that goal through role-modeling and mentoring. Supervisors believe that a bond of trust between supervisor and resident is a prerequisite to properly support residents’ PIF. Show less
Purpose Supporting the development of a professional identity is a primary objective in postgraduate education. Few empirical studies have explored professional identity formation (PIF) in... Show morePurpose Supporting the development of a professional identity is a primary objective in postgraduate education. Few empirical studies have explored professional identity formation (PIF) in residency, and little is known about supervisors' perceptions of their roles in residents' PIF. In this study, we sought to understand how supervisors perceive their roles in the PIF of General Practice (GP) residents. Materials and methods Guided by principles of qualitative description, we conducted eight focus groups with 55 supervisors at four General Practice training institutes across the Netherlands. Informed by a conceptual framework of PIF, we performed a thematic analysis of focus group transcripts. Results Three themes related to how GP supervisors described their roles in supporting residents' PIF: supervising with the desired goal of GP training in mind; role modeling and mentoring as key strategies to achieve that goal; and the value of developing bonds of trust to support the process. Conclusions To our knowledge, this study is the first to explore PIF in GP training from the perspective of clinical supervisors. The identified themes mirror the components of the therapeutic alliance between doctors and patients from a supervisor's perspective and highlight the pivotal roles of the supervisor in a resident's PIF. Show less
Background Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later... Show moreBackground Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. Methods We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. Results Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. Conclusions The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation. Show less
This research explores how undergraduate programmes in early childhood education in Chile have contributed to the construction of a knowledge base relevant to the profession. As a descriptive... Show moreThis research explores how undergraduate programmes in early childhood education in Chile have contributed to the construction of a knowledge base relevant to the profession. As a descriptive multiple case study, it analyses the evolution of the plans of study in five programmes, between 1981 and 2015. Relying on major theoretical perspectives on professionalism, the analysis emphasizes the attributes of the knowledge base of professionalism, and the role of universities in constructing and transmitting the professions’ knowledge base. Findings show that undergraduate preparation has gone through three phases involving different conceptualizations on early childhood teachers: technical (1944-1967), teaching specialty (1968-1998), and profession (1999-2015). Furthermore, the five cases have not been able to construct a theoretically solid knowledge base. Nor have they been able to decisively incorporate three largely agreed-upon elements of their identity knowledge, or to satisfactorily resolve tensions regarding their own knowledge base. Remarkably, different theoretical perspectives on professionalism point in the same direction. This research concludes that the five cases have had little influence on constructing their own knowledge base. Thus, the evolution of their plans of study has been similar to a process of professionalization driven “from above” being the Ministry of Education the leading actor. Show less
Individuals who work in the public sector see themselves confronted with conflicting values, contradictory demands, and the need to serve an at times difficult to define __public interest__. This... Show moreIndividuals who work in the public sector see themselves confronted with conflicting values, contradictory demands, and the need to serve an at times difficult to define __public interest__. This book contributes to our understanding of what drives public service professionals__ decision-making in real-life dilemma situations by looking into the combined effect of public service motivation (PSM) and professionalism. Because there are persistent knowledge gaps about the meaning and behavioural consequences of these concepts when it comes to the context of dilemma situations, this book presents new approaches to the study of PSM and professionalism. Another important contribution of this study is related to the discussion about the stability of PSM. Several hypotheses and propositions are put to the test within a mixed-method research design based on data from research on Dutch veterinary inspectors. The results show that in order to clarify the meaning and behavioural consequences of PSM and professionalism in the context of dilemmas it is useful to combine our understanding of these two concepts with insights from identity theory. Mixed findings regarding the relationship between PSM and professionalism highlight our incomplete conceptual understanding of the topics studied, and call for future research that is sensitive to role perceptions. Show less
