{"id":1515,"date":"2020-12-15T09:13:30","date_gmt":"2020-12-15T01:13:30","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=1515"},"modified":"2021-05-04T08:33:18","modified_gmt":"2021-05-04T00:33:18","slug":"using-a-consensus-approach-to-develop-a-medical-professionalism-framework-for-the-sri-lankan-context","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/using-a-consensus-approach-to-develop-a-medical-professionalism-framework-for-the-sri-lankan-context\/","title":{"rendered":"Using a consensus approach to develop a medical professionalism framework for the Sri Lankan context"},"content":{"rendered":"<p>Submitted: 15 April 2020<br \/>\r\nAccepted: 5 June 2020<br \/>\r\nPublished online: 5 January, TAPS 2021, 6(1), 49-59<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/OA2248\">https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/OA2248<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Amaya Tharindi Ellawala<sup>1<\/sup>, Madawa Chandratilake<sup>2<\/sup> &amp; Nilanthi de Silva<sup>2<\/sup><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Medical Education, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka<\/span><\/i><span lang=\"EN-GB\">; <i><sup>2<\/sup>Faculty of Medicine, University of Kelaniya, Sri Lanka<\/i><\/span><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> Professionalism is a context-specific entity, and should be defined in relation to a country\u2019s socio-cultural backdrop. This study aimed to develop a framework of medical professionalism relevant to the Sri Lankan context.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> An online Delphi study was conducted with local stakeholders of healthcare, to achieve consensus on the essential attributes of professionalism for a doctor in Sri Lanka. These were built into a framework of professionalism using qualitative and quantitative methods.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Results:<\/span><\/b><span lang=\"EN-GB\"> Forty-six attributes of professionalism were identified as essential, based on Content Validity Index supplemented by Kappa ratings. \u2018Possessing adequate knowledge and skills\u2019, \u2018displaying a sense of responsibility\u2019 and \u2018being compassionate and caring\u2019 emerged as the highest rated items. The proposed framework has three domains: professionalism as an individual, professionalism in interactions with patients and co-workers and professionalism in fulfilling expectations of the profession and society, and displays certain characteristics unique to the local context.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Conclusion:<\/span><\/b><span lang=\"EN-GB\"> This study enabled the development of a culturally relevant, conceptual framework of professionalism as grounded in the views of multiple stakeholders of healthcare in Sri Lanka, and prioritisation of the most essential attributes.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Professionalism, Culture, Consensus<\/span><\/i><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: left\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Medical professionalism is recognised as a culturally dependent entity.<\/span><\/li>\r\n\t<li style=\"text-align: left\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">This has led to the emergence of definitions unique to socio-cultural settings.<\/span><\/li>\r\n\t<li style=\"text-align: left\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">List-based definitions provide operationalisable means of portraying its meaning.<\/span><\/li>\r\n\t<li style=\"text-align: left\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">A Delphi study was conducted to achieve consensus on locally relevant professionalism attributes.<\/span><\/li>\r\n\t<li style=\"text-align: left\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Using quantitative and qualitative methods, a conceptual framework of professionalism was developed.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<ol><\/ol>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">There is no single definition of medical professionalism that encompasses its many subtle nuances (Birden et al., 2014).\u00a0 The realisation that professionalism is a dynamic, multi-dimensional entity (Van de Camp, Vernooij-Dassen, Grol, &amp; Bottema, 2004), significantly dependent on context (Van Mook et al., 2009), and cultural backdrop (Chandratilake, Mcaleer, &amp; Gibson, 2012), has led to the emergence of definitions specific to cultures and socio-economic backgrounds. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Many of the current definitions originate from Western societies. Certain Eastern cultures have embraced such definitions, though they are undeniably in conflict with local traditional views (Pan, Norris, Liang, Li, &amp; Ho, 2013). In parallel however, countries such as Egypt, Saudi Arabia, Japan, China and Taiwan have explored how professionalism is conceptualised within their contexts (Al-Eraky, Chandratilake, Wajid, Donkers, &amp; Van Merrienboer, 2014; Leung, Hsu, &amp; Hui, 2012; Pan et al., 2013). Such studies have portrayed the interplay between cultural, socio-economic and religious factors in shaping perceptions on professionalism, further fuelling the notion that professionalism must be \u201cinterpreted in view of local traditions and ethos\u201d (Al-Eraky et al., 2014, p. 14).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Culture is the embodiment of elements such as attitudes, beliefs and values that are shared among individuals of a community and is therefore, an entity that distinguishes one group of people from another (Hofstede, 2011). Various cultural theories provide insight into inter-cultural differences across the globe (Hofstede, n.d.; Schwartz, 1999). The Sri Lankan cultural context, while aligned with those of its closest geographical neighbours in South Asia in some ways, differs from them in other important aspects.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Certain attempts have been made to explore the meaning of professionalism in Sri Lanka. Chandratilake et al. (2012) provided a degree of insight while comparing cultural similarities and dissonances in conceptualising professionalism among doctors of several nations. Monrouxe, Chandratilake, Gosselin, Rees, and Ho (2017) built on this work with their analysis of professionalism as viewed by local medical students. The sole regulatory authority of the medical profession in the country, the Sri Lanka Medical Council (SLMC, 2009) has delineated what it expects in terms of professionalism, by outlining the constituents of \u2018good medical practice\u2019, many of which converge with elements of professionalism described in the literature.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">While the work mentioned here has shed some light on the topic, to our knowledge, there were no studies that focused solely on the local conceptualisation of professionalism, drawing on the views of diverse stakeholders of healthcare. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">There exist two schools of thought on how professionalism can be defined: as a list of desirable attributes (Lesser et al., 2010), or as an over-arching, value-laden entity that transcends such lists (Irby &amp; Hamstra, 2016; Wynia, Papadakis, Sullivan, &amp; Hafferty, 2014). Unlike the latter, a list may not address the \u201cfoundational purpose of professionalism\u201d (Wynia et al., 2014, p. 712); however, it will provide a tangible, operationalisable portrayal (Lesser et al., 2010). It is possibly for this reason that many studies have opted for list-based definitions, an approach that is supported in the East (Al-Eraky &amp; Chandratilake, 2012; Al-Eraky et al., 2014; Pan et al., 2013).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The aim of this study was to develop a culturally appropriate conceptual framework of medical professionalism in Sri Lanka using a combination of qualitative and quantitative methods. We envisioned that identifying a list of desirable attributes would be appropriate, providing a definition that could readily be operationalised for teaching\/learning, assessment and research purposes (Wilkinson, Wade, &amp; Knock, 2009).<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. The Approach<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">We followed a consensus approach, and opted for the Delphi technique as it was imperative to involve a large number of participants not limited by geographical location (Humphrey-Murto et al., 2017). The method offered the further advantage of providing participants with equal opportunity to express their opinions (De Villiers, De Villiers, &amp; Kent, 2005), thereby negating the possible drawbacks of face-to-face interactions and resulting in a \u2018process gain\u2019 (Powell, 2003).<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Participant Panel<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The panel comprised nation-wide stakeholders of healthcare (Table 1), from both rural and urban regions who were presumably exposed to diverse forms of medical services and geographical variations in their distribution.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"0\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><b><span lang=\"EN-GB\">Stakeholder group<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><b><span lang=\"EN-GB\">Description<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><b><span lang=\"EN-GB\">Number<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Medical teachers<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Four Medical Faculties (nation-wide)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">69 (44%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Medical students <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Four Medical Faculties (nation-wide) &#8211; fourth and final years<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">36 (23%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Hospital doctors<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Four Teaching Hospitals (nation-wide)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">14 (9%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Healthcare staff<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Selected secondary and tertiary hospitals<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">5 (3%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">General practitioners<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Selected GP practices around the country<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">2 (1%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Medical administrators<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Selected secondary and tertiary hospitals <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">5 (3%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">Policy makers in healthcare<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Ministry of Health, professional associations and regulatory bodies<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">2 (1%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 178.667px\">\r\n<p><span lang=\"EN-GB\">\u00a0General public<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 340px\">\r\n<p><span lang=\"EN-GB\">Employees of selected private and state banks<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Non-academic staff of four Medical Faculties <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Teachers of selected private and state schools<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 104.667px\">\r\n<p><span lang=\"EN-GB\">25 (16%)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 1. Composition of the Delphi panel<\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: justify\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">1) Delphi Round I: <\/span><\/i><span lang=\"EN-GB\">The question posed in the first round was \u2018What are the attributes of professionalism you would expect in a doctor working in the Sri Lankan context?\u2019. No limitation was posed on the number of answers to this open-ended question. This was piloted among a group comprising local medical educationists, medical officers and members of public and edited based on their feedback. Invitations to participate were emailed and informed consent was obtained through an online link. Participants were then automatically granted access to the online questionnaire. An email reminder was sent to the initial mailing list after one week. The questionnaire was accessible for three weeks from the date of launch. Invitations were emailed to 920 individuals, of which 158 (17.2%) responded.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">To analyse the data of Round I, we used conventional content analysis, which is employed when literature and theory on a phenomenon is limited, thereby allowing themes to emerge from and be grounded in the data itself (Hsieh &amp; Shannon, 2005). Initially, individual responses &#8211; considered as meaning units &#8211; were listed out verbatim, removing exact duplicates. Meaning units varied from single word responses to longer phrases, and were therefore divided into short and long meaning units. The latter were shortened into condensed meaning units, while preserving the original meaning. Finally, condensed and short meaning units were coded. Similar phrases were assigned the same code. A final scrutiny of the codes allowed the removal of synonymous items and coupling of items with similar meaning. We followed this process iteratively till the items had been refined to the maximum extent possible.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">With two additional experts, we reviewed the appropriateness of items. Four common misconceptions of professionalism (distractors) were added, in order to prevent inattentive responses to the large number of items included in the subsequent round (Meade &amp; Craig, 2012). A search of literature also revealed a number of evidenced-based items that had not emerged in the data. Three of these were agreed to be relevant and important to the local context, and were therefore added to the list, to ensure that a comprehensive coverage of items was achieved.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">2) Delphi Round II: <\/span><\/i><span lang=\"EN-GB\">The attributes of professionalism were compiled into another online survey and emailed to all individuals initially invited to participate in the study, three weeks after completion of the first round; 118 of the initial sample (dropout rate = 25.3%) participated in Round II. Respondents were asked to rate each item on a five-point Likert scale ranging from \u2018not important\u2019 to \u2018very important\u2019, according to perceived importance in the local context. An email reminder was sent out after one week. The form was accessible for three weeks.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The aim of this second round was to select the attributes considered most essential. Content Validity Index (CVI) was chosen for this purpose, over less rigorous methods such as prioritisation by mean. The CVI is the proportion of respondents rating an item as essential (Polit &amp; Beck, 2006). Responses \u20184\u2019 and \u20185\u2019of the Likert scale were determined as reflecting \u2018essentialness\u2019. The general acceptance is that in a study with a large number of raters (as in this case), a CVI &gt; 0.78 will indicate that an item is essential (Lynn, 1986).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">To avoid the possibility of agreement being due to chance, Kappa statistics &#8211; a measure of inter-rater agreement and the probability of chance responses &#8211; were computed. K-values can range from -1 to +1; -1 indicating perfect disagreement below chance, +1, perfect agreement above chance and 0, agreement equal to chance (Randolph, n.d.). A K-value \u22650.7 indicates acceptable inter-rater agreement. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">As the final step, the prioritised list of attributes was emailed to participants requesting further comments; however, none were received. The Delphi study concluded at this stage.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">In order to organise the attributes in a more meaningful manner, we attempted to identify the emerging domains of professionalism. Initially this was performed through an Exploratory Factor Analysis, a method which allows identification of underpinning, latent \u2018factors\u2019 that are inferred from the variables. Scholars have recommended however, that quantitative analysis of studies with a social science perspective be complemented with qualitative methods (Tavakol &amp; Sandars, 2014). Therefore, a panel of experts individually sorted the attributes into themes using the constant comparison technique; data was sorted, systematically compared and the emergence of a theme was acknowledged when many similar items appeared across the data set (Maykut &amp; Morehouse, 1994). The results were compared with those of the Factor Analysis and by identifying common domains, a final framework of professionalism was formulated. As an additional measure, the internal consistency (Cronbach\u2019s Alpha) within each domain was computed to determine close clustering of items. The framework developed was vetted by a group of reviewers.<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Profile of Participant Panel<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The response rates of the different participant groups are depicted in Table 1. As demographic details were not re-obtained in Round II, the profile of this group could not be determined.<\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Results of Round I<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A total of 288 items were initially documented, and condensed to 53 attributes following content analysis. The three evidence-based items and four distractors were added to make a final inventory of 60 items (Table 2).<\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Results of Round II<\/span><\/i><\/p>\r\n<p align=\"center\" style=\"text-align: justify\"><i><span lang=\"EN-GB\">1) Essential Attributes of Professionalism: <\/span><\/i><span lang=\"EN-GB\">Forty-six items achieved a CVI &gt; 0.78 and were therefore labelled as \u2018essential\u2019. The attributes are arranged in descending order of importance in Table 2. The Kappa value was 0.77, confirming that rating of items was not due to chance.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Attribute of professionalism<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">CVI<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Possessing adequate medical knowledge and skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.99<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying a sense of responsibility<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.98<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being compassionate and caring<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Managing limited resources for optimal outcome<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ensuring confidentiality and patient privacy<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being punctual<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining standards in professional practice<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying effective communication skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying honesty and integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying commitment to work<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.97<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being empathetic towards patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.96<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being able to work as a member of a team<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.96<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being reliable<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.96<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying professional behaviour and conduct<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.96<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accountable for one&#8217;s actions and decisions<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.96<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being available<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.95<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being responsive<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.95<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being clear in documentation<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.95<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being patient<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.94<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying effective problem-solving skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.94<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Understanding limitations in professional competence<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.94<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being respectful and polite<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.94<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ability to effectively manage time<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.93<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being a committed teacher\/supervisor<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.92<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being open to change<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.92<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Commitment to continuing professional development<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.91<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Having scientific thinking and approach<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.91<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accurate and meticulous<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.91<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining work-life balance<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.91<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying self confidence<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.91<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ability to provide and receive constructive criticism<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.90<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Non-judgmental attitude and ensuring equality<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.90<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Engaging in reflective practice <\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.90<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Respecting patient autonomy<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.90<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accessible<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.88<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Avoiding substance and alcohol misuse*<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.86<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Working towards a common goal with the health system<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.85<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Providing leadership<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.84<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being humble<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.84<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Advocating for patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.83<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining professional relationships<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.83<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Adhering to a professional dress code<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.82<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Avoiding conflicts of interest<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.82<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying sensitivity to socio-cultural and religious issues related to patient care<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.81<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being composed<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.80<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Stands for professional autonomy**<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.79<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being amiable<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.77<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying sensitivity to socio-cultural and religious issues in dealing with colleagues and students*<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.76<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being assertive<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.75<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being creative in work related matters<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.74<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Not money minded<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.73<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Willingness to work in rural areas<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.72<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Respecting professional hierarchy**<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.69<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Possessing knowledge in areas outside of medicine<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.68<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being altruistic <\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.65<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Adhering to socio-cultural norms* <\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.64<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Fluency in multiple languages<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.62<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Abiding by religious beliefs<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.32<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying self-importance**<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.19<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"485\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Using professional status for personal advantage**<\/span><\/p>\r\n<\/td>\r\n<td width=\"68\" nowrap=\"nowrap\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">0.07<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\"><span style=\"font-size: 10pt\">Note: *Evidence-based items sourced from the literature <\/span><\/span><span lang=\"EN-GB\" style=\"font-size: 10pt\">**Distractors <\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 2. Attributes of professionalism arranged in order of perceived importance<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The highest rated attributes were, \u2018possessing adequate medical knowledge and skills\u2019, followed by \u2018displaying a sense of responsibility\u2019 and \u2018being compassionate and caring\u2019. Five items were mentioned collectively across the main stakeholder groups:<\/span><\/p>\r\n<ul type=\"disc\" style=\"text-align: justify\">\r\n\t<li><span lang=\"EN-GB\">Being empathetic towards patients<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\">Possessing adequate knowledge and skills<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\">Displaying effective communication skills<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\">Displaying honesty and integrity<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\">Being respectful and polite<\/span><i><span lang=\"EN-GB\"><\/span><\/i><\/li>\r\n<\/ul>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">2) Development of a Professionalism Framework: <\/span><\/i><span lang=\"EN-GB\">The main themes of professionalism identified by the expert panel and through exploratory factor analysis are summarised in Table 3.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"127\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Panelist 1<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Panelist 2<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Panelist 3<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Factor Analysis<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"127\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Professionalism in interactions with patients (1)<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Interpersonal (1,2)<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Competency &#8211; Competency in managing patients and clinical reasoning (3)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Qualities required to effectively work within the healthcare team (2)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"127\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Professionalism in interactions in the workplace (2)<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Intrapersonal (4)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Accountability &#8211; Taking responsibility for work performed as a doctor in the clinical context and in interactions with co-workers (2)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Clinical competency, excellence and continuous development (3)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"127\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Professionalism in fulfilling expectations of the profession and society (3)<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Societal\/public (3)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Attitude &#8211; Thought process, internal qualities of the doctor (4)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Equal and fair treatment of patients (1)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"127\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Behaviour &#8211; External actions of the doctor (1)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"115\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Humane qualities in dealing with patients (1)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 3. Themes of professionalism identified quantitatively and qualitatively*<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Based on the convergence of these domains, a framework was developed, which portrayed professionalism as encompassing three main elements: individual traits, inter-personal interactions and responsibilities to the profession and community (Figure 1). Cronbach Alpha values for the three domains were 0.882, 0.918 and 0.755, thereby confirming the relevance of the constituents to each overarching element.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/OA2248-Fig1-2.png\" alt=\"\" class=\"alignnone wp-image-1518 size-full\" width=\"842\" height=\"538\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/OA2248-Fig1-2.png 842w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/OA2248-Fig1-2-300x192.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/OA2248-Fig1-2-768x491.png 768w\" sizes=\"auto, (max-width: 842px) 100vw, 842px\" \/><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Professionalism in interactions with patients and co-workers<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Professionalism as an individual<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Professionalism in fulfilling expectations of the profession and society<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ensuring confidentiality and patient privacy<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying a sense of responsibility<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Managing limited resources for optimal outcome<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying effective communication skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being punctual<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining standards in professional practice<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being empathetic towards patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying honesty and integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying professional behaviour and conduct<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being able to work as a member of a team<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying commitment to work<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Working towards a common goal with the health system<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being available<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being reliable<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Adhering to a professional dress code<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being responsive<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accountable for one&#8217;s actions and decisions<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Avoiding conflicts of interest<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being respectful and polite<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being clear in documentation<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Stands for professional autonomy<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being a committed teacher\/supervisor<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying effective problem-solving skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Possessing adequate medical knowledge and skills<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Respecting patient autonomy<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Understanding limitations in professional competence<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining work-life balance<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accessible<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ability to effectively manage time<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Avoiding substance and alcohol misuse<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Providing leadership<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being open to change<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Advocating for patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Commitment to continuing professional development<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining professional relationships<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Having scientific thinking and approach<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying sensitivity to socio-cultural and religious issues related to patient care<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being accurate and meticulous<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being compassionate and caring<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Displaying self confidence<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being patient<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Non-judgemental attitude and ensuring equality<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ability to provide and receive constructive criticism<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Engaging in reflective practice <\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\"><\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being humble<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Being composed<\/span><\/p>\r\n<\/td>\r\n<td width=\"208\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Figure 1. A framework of medical professionalism for Sri Lanka<\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p align=\"justify\" style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Framework of Professionalism Attributes<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The framework depicts a progressively widening circle, with desirable individual traits at its core, expanding into interactions within the workplace and finally, responsibilities as a professional in wider society. It thus depicts the fundamental areas that must be addressed in aspiring towards professionalism. The three domains are largely congruent with the broad areas of professionalism described by Van de Camp et al. (2004) and Hodges et al. (2011). Though portrayed as distinct entities however, we emphasise that the domains should not be interpreted as evolving in sequential stages; professional development should ideally occur in these areas simultaneously. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Frameworks developed in other Eastern cultures have highlighted significant tenets of local traditions and ethos that have shaped perceptions on professionalism. Confucian values in Taiwan (Ho, Yu, Hirsh, Huang, &amp; Yang, 2011), principles of Bushido in Japan (Nishigori, Harrison, Busari, &amp; Dornan, 2014), and Islamic teachings within Egypt (Al-Eraky et al., 2014), have been shown to be deeply entrenched within such understandings. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Sri Lanka possesses a rich and diverse cultural heritage. British ideologies in particular appear to influence local medical education (Uragoda, 1987), and the conceptualisation of professionalism (Babapulle, 1992; Monrouxe et al., 2017), resulting in a strong emphasis on ethical behaviour. Sri Lanka is widely acknowledged to have a \u2018religious\u2019 background. Theravada Buddhism, the religion followed by the majority of Sri Lankans, as well as less widespread religions such as Christianity, Hinduism and Islam, exert a significant influence on local culture (Gildenhuys, 2004). Virtues collectively upheld by these doctrines, such as generosity, impartiality, honesty and peace are thought to be central to the development of professionalism (Keown, 2002). Of these, honesty, impartiality (equality) and peace (composure) were echoed within the theme \u2018professionalism as an individual\u2019, as were responsibility, reliability and accountability. These characteristics, built on a foundation of integrity, are fundamental tenets of Sri Lanka\u2019s socio-cultural framework. Thus, we reasoned that \u2018professionalism as an individual\u2019 was ideally depicted as central to the local concept of professionalism, highlighting the importance of building a solid foundation of fundamental characteristics. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">We also drew on elements of the \u2018cultural dimension\u2019 (Hofstede, n.d.) and \u2018cultural value\u2019 (Schwartz, 1999) theories in developing the framework. Accordingly, the collectivist nature of local culture provides the basis for qualities that enable harmonious interactions with others, as depicted in the second domain. The hierarchical disposition of local society dictates that the doctor is duty-bound to ensure that responsibilities to the profession and community are met.<\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Essential Attributes of Professionalism<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Among the essential items, broad areas encompassing competence, humanism, interpersonal skills and ethics were prioritised. Qualities most consistently mentioned in literature &#8211; accountability, integrity and respect \u2013 received high ratings (Van de Camp et al., 2004). Reflective practice, understanding limitations in practice, accepting constructive criticism and continuous professional development &#8211; \u2018cornerstones\u2019 of the medical profession \u2013 were also labelled as significant (Chandratilake et al., 2012; Wynia et al., 2014), in contrast to other Eastern settings (Adkoli, Al-Umran, Al-Sheikh, Deepak, &amp; Al-Rubaish, 2011). The striking omission was altruism, which was intriguingly rated as non-essential. Altruism has been named as one of the most consistently valued attributes of professionalism worldwide (Van de Camp et al., 2004), and would assumedly be espoused in the local collectivist culture. Our findings suggest that even qualities accepted as key tenets of professionalism may not be equally valued cross-culturally. However, it has been claimed that altruism is traditionally a Western concept (Nishigori et al., 2014), and the acceptance of altruism as a composite of professionalism has been challenged in recent years, on the premise that selflessness may in fact be causing considerable harm (Harris, 2018; Nishigori, Suzuki, Matsui, Busari, &amp; Dornan, 2019).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Participants rated \u2018possessing adequate medical knowledge and skills\u2019 as the most essential professionalism attribute. This coincides with findings from Canada (Brownell &amp; Cote, 2001) and Asia (Leung et al., 2012; Pan et al., 2013), though conflicting with a school of thought that considers competence to be the foundation of professionalism, rather than an integral part of it (Stern, 2006). The primacy afforded to knowledge and skills most likely stems from the significance placed on education, which is upheld in Sri Lanka as the primary means of elevating one\u2019s socio-economic status. The emphasis on responsibility and compassion \u2013 the second and third highest rated items \u2013 as well as morality and empathy, can be attributed to the deeply religious background of the country. It was unsurprising that respectfulness was prioritised, being a cardinal virtue embraced by Sri Lankans, as in other Eastern settings (Nishigori et al., 2014). <\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: justify\"><span lang=\"EN-GB\">A comparison of professionalism attributes hailed as important in various contexts, with the highest rated qualities locally, revealed a convergence of several items (Table 4). This provides assurance that the local conceptualisation of professionalism reflects the \u2018core\u2019 principles of medical professionalism and shows considerable alignment with definitions provided by professional bodies around the world (General Medical Council [GMC], 2013; Medical Professionalism Project, 2002).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Sri Lanka<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">USA<\/span><\/b><\/p>\r\n<p><span lang=\"EN-GB\">(American Board of Internal Medicine, 2001)<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Western countries<\/span><\/b><\/p>\r\n<p><span lang=\"EN-GB\">(Hilton &amp; Slotnick, 2005)<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Canada<\/span><\/b><\/p>\r\n<p><span lang=\"EN-GB\">(Steinert, <\/span><span lang=\"EN-US\">Cruess, Cruess, Boudreau, &amp; Fuks, <\/span><span lang=\"EN-GB\">2007)<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Taiwan<\/span><\/b><\/p>\r\n<p><span lang=\"EN-GB\">(Ho et al., 2011)<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">China<\/span><\/b><\/p>\r\n<p><span lang=\"EN-GB\">(Pan et al., 2013)<b><\/b><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Knowledge and skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Competence<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Clinical competence<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Clinical competence<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Responsibility<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Accountability<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Accountability <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Social responsibility<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Responsibility<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Accountability<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Accountability<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Compassion and caring<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Humanism<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Humanism<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Managing limited resources for optimal outcome<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Economic consideration<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Confidentiality and patient privacy<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Punctuality<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Maintaining standards in professional practice<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Excellence<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Excellence<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Excellence<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Effective communication skills<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Communication<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Communication<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Honesty and integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Honesty<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Integrity<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Commitment to work<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Duty<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Commitment<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Altruism<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Altruism<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Altruism<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Altruism\u00a0 <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Respect<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Respect <\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Self-awareness<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Reflection<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Self-regulation<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Self-management<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Teamwork<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Teamwork<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Teamwork<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ethical practice<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ethics <\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ethics<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Ethics<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Morality<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Morality<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Honour<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Autonomy<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"106\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Health promotion<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 4. Comparison of main attributes of professionalism identified locally with those of Western and Eastern contexts<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Interestingly, certain items globally recognised as insignificant in terms of professionalism (work-life balance, leadership, professional appearance and composure) (Chandratilake et al., 2012), were highlighted as essential locally. The local expectation that professionals maintain an appearance befitting of their social status and the high power-distance between doctor and patient (Hofstede, n.d.), could have contributed to the emphasis on appearance. Similarly, power distance could explain the significance placed on leadership, a crucial skill required to handle subordinates and patients at the \u2018lower end\u2019 of the power spectrum. A promising finding was the importance placed on \u2018work-life balance\u2019, complementing the lack of emphasis on altruism and coinciding with recommendations of multiple professional bodies that underscore the value of personal well-being (GMC, 2013). The significance assigned to composure can be attributed to Sri Lanka\u2019s conservative nature (Schwartz, 1999), where cultural norms dictate that public displays of intense emotion be suppressed.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">It was intriguing to note that of the four distractors\u2014which were expected to be rated as non-essential\u2014 \u2018stands for professional autonomy\u2019 achieved a CVI just above the baseline. In Sri Lanka, political influence is known to permeate into the workplace; therefore, this attribute can be viewed in light of being able to perform one\u2019s duties in the midst of such pressures. The paternalistic nature of the doctor-patient relationship common to many Eastern cultures, could also underpin the significance afforded to professional autonomy (Ho &amp; Al-Eraky, 2016; Susilo, Marjadi, van Dalen, &amp; Scherpbier, 2019). Incidentally, this item was not corroborated elsewhere in the literature and was therefore, unique to this study. Other items that were exclusive to the Sri Lankan context were clarity in documentation, patience, time management and maintaining professional relationships.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">As a whole, it is evident that the local conceptualisation of professionalism\u2014while including areas unique to the Sri Lankan context\u2014greatly coincides with the perceptions representing professionalism shared by the global medical community. <\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Strengths and Limitations<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The study has responded to calls for culture-specific discourse on professionalism (Monrouxe et al., 2017) and prioritisation of essential qualities in terms of professionalism (Jha, Bekker, Duffy, &amp; Roberts, 2007). Many studies seeking to define professionalism have drawn on the views of particular stakeholder groups in isolation; few have attempted to collate the views of the many groups (Ho et al., 2011; Leung et al., 2012; Pan et al., 2013). Scholars have challenged the medical profession to determine who should define professionalism, with the belief that this onus should not be placed solely on doctors (Wear &amp; Kuczewski, 2004). The assimilation of views of multiple stakeholder groups therefore, was a significant strength of this study. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Although the initial list of 920 individuals who were invited to participate in the study was representative of all groups of stakeholders, the majority of those who responded were medical teachers and students. Thus, the study results predominantly reflect the views of these two groups. This may have precluded identification of attributes considered essential by the less represented groups, especially the public.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Another limitation of the study was the exclusive use of English, which though widely used in Sri Lanka, is not the first language of the majority of the population. The decision was justified as all potential participant groups were posited to be adequately fluent in English to participate. However, we recognise that providing the option of Sinhalese and Tamil translations may have increased participation in certain groups (healthcare staff and the public).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Finally, we acknowledge that while this framework reflects the current perception regarding medical professionalism, this notion is far from static, and will undeniably evolve with time. We therefore propose that future research involve repeated discussions that may inform the evolution of the current framework with time, being mindful of achieving a fair balance of stakeholder representation to this end.<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This study has enabled us, through a consensus seeking approach, to paint a picture of medical professionalism as grounded in the views of the multiple stakeholders of healthcare in Sri Lanka. The conceptual framework that represents these opinions, reflects how perceptions on professionalism are shaped by cultural, societal, religious, economic and other factors. Moreover, it has enabled identification of individual elements of professionalism that are expected of a doctor in the local context, and prioritisation of those most essential among them.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Amaya Ellawala MBBS, PGDME, MD, is a Lecturer in Medical Education in the Department of Medical Education, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Amaya Ellawala reviewed the literature, developed the methodological framework for the study, performed data collection, analysis and wrote the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Madawa Chandratilake MBBS, MMed, PhD, is a Professor of Medical Education at the Department of Medical Education, Faculty of Medicine, University of Kelaniya, Sri Lanka. Madawa Chandratilake contributed to the development of the methodological framework, data analysis and writing of the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Nilanthi de Silva MBBS, MSc, MD, is a Senior Professor in the Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka. Nilanthi de Silva contributed to the development of the methodological framework, data analysis and writing of the manuscript. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">All authors read and approved the final manuscript.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ethics approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (P\/15\/01\/2016).<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This study was not funded.<\/span><\/p>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The authors declare that they have no competing interests.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Adkoli, B. V., Al-Umran, K. U., Al-Sheikh, M., Deepak, K. K., &amp; Al-Rubaish, A. M. (2011). Medical students\u2019 perception of professionalism: A qualitative study from Saudi Arabia. <i>Medical Teacher, 33<\/i>(10), 840\u2013845. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Al-Eraky, M. M., &amp; Chandratilake, M. (2012). How medical professionalism is conceptualised in Arabian context: A validation study. <i>Medical Teacher, 34<\/i>(S1), S90\u2013S95.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Al-Eraky, M. M., Chandratilake, M., Wajid, G., Donkers, J., &amp; Van Merrienboer, J. G. (2014). A Delphi study of medical professionalism in Arabian Countries: The Four-Gates Model. <i>Medical Teacher, 36<\/i>, S8\u2013S16.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">American Board of Internal Medicine. (2001). <i>Project Professionalism<\/i>. Philadelphia, USA: American Board of Internal Medicine.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Babapulle, C. J. (1992). Teaching of medical ethics in Sri Lanka. <i>Medical Education, 26<\/i>(3), 185\u2013189.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T., &amp; Nass, D. (2014). Defining professionalism in medical education: A systematic review. <i>Medical Teacher, 36<\/i>(1), 47\u201361. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Brownell, A. K. W., &amp; Cote, L. (2001). Senior residents\u2019 views on the meaning of professionalism and how they learn about it. <i>Academic Medicine, 76<\/i>(7), 734\u2013737.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Chandratilake, M., Mcaleer, S., &amp; Gibson, J. (2012). Cultural similarities and differences in medical professionalism: A multi-region study. <i>Medical Education, 46<\/i>(3), 257\u2013266.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">De Villiers, M. R., De Villiers, P. J. T., &amp; Kent, A. P. (2005). The Delphi technique in health sciences education research. <i>Medical Teacher, 27<\/i>(7), 639\u2013643.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">General Medical Council. (2013). <i>Good Medical Practice<\/i>. London, UK: GMC.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Gildenhuys, J. S. H. (2004). <i>Ethics and Professionalism. Stellenbosch<\/i>. South Africa: Sun Press.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Harris, J. (2018). Altruism: Should it be included as an attribute of medical professionalism? <i>Health Professions Education, 4<\/i>, 3\u20138.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Hilton, S. R., &amp; Slotnick, H. B. (2005). Proto-professionalism: How professionalisation occurs across the continuum of medical education. <i>Medical Education, 39<\/i>, 58\u201365.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ho, M., &amp; Al-Eraky, M. (2016). Professionalism in context: Insights from the United Arab Emirates and beyond. <i>Journal of Graduate Medical Education, 8<\/i>(2), 268\u2013270.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ho, M., Yu, K., Hirsh, D., Huang, T., &amp; Yang, P. (2011). Does one size fit all? Building a framework for medical professionalism. <i>Academic Medicine, 86<\/i>(11), 1407\u20131414.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Hodges, B. D., Ginsburg, S., Cruess, R., Cruess, S., Delport, R., Hafferty, F., \u2026 Wade, W. (2011). Assessment of professionalism: Recommendations from the Ottawa 2010 conference. <i>Medical Teacher, 33<\/i>(5), 354\u2013363.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Hofstede, G. (n.d.). <i>Cultural Dimensions<\/i>. Retrieved from <\/span><span lang=\"EN-US\"><a href=\"http:\/\/geerthofstede.com\/culture-geert-hofstede-gert-jan-hofstede\/6d-model-of-national-culture\/\"><span lang=\"EN-GB\">http:\/\/geerthofstede.com\/culture-geert-hofstede-gert-jan-hofstede\/6d-model-of-national-culture\/<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. <i>Online Reading in Psychology and Culture, 2<\/i>(1), 1\u201326.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Hsieh, H., &amp; Shannon, S. E. (2005). Three approaches to qualitative content analysis. <i>Qualitative Health Research, 15<\/i>(9), 1277\u20131288.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Humphrey-Murto, S., Varpio, L., Wood, T. J., Gonsalves, C., Ufholz, L., Mascioli, K., \u2026 Foth, T. (2017). The use of the Delphi and other consensus group methods in medical education research. <i>Academic Medicine, 92<\/i>(10), 1491\u20131498.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Irby, D. M., &amp; Hamstra, S. J. (2016). Parting the clouds: Three professionalism frameworks in medical education. <i>Academic Medicine, 91<\/i>(12), 1606\u20131611.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Jha, V., Bekker, H. L., Duffy, S. R. G., &amp; Roberts, T. E. (2007). A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine. <i>Medical Education, 41<\/i>, 822\u2013829.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Keown, D. (2002). Buddhism and medical ethics. <i>Principles of Practice, 7<\/i>, 39\u201370. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Lesser, C. S., Lucey, C. R., Egener, B., Braddock, C. H., Linas, S. L., &amp; Levinson, W. (2010). A behavioral and systems view of professionalism. <i>Journal of the American Medical Association, 304<\/i>(24), 2732\u20132737.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Leung, D. C., Hsu, E. K., &amp; Hui, E. C. (2012). Perceptions of professional attributes in medicine: A qualitative study in Hong Kong. <i>Hong Kong Medical Journal, 18<\/i>(4), 318\u2013324.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Lynn, M. R. (1986). Determination and quantification of content validity. <i>Nursing Research, 35<\/i>, 382\u2013385.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Maykut, P., &amp; Morehouse, R. (1994). <i>Beginning Qualitative Research: A Philosophic and Practical Guide<\/i>. London, UK: Falmer Press.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Meade, A. W., &amp; Craig, S. B. (2012).\u00a0 Identifying careless responses in survey data. <i>Psychological Methods, 17<\/i>(3), 437-455.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Medical Professionalism Project. (2002). Medical professionalism in the new millennium: A physicians\u2019 charter. <i>The Lancet, 359<\/i>, 520-522. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Monrouxe, L. V., Chandratilake, M., Gosselin, K., Rees, C. E., &amp; Ho, M. J. (2017). Taiwanese and Sri Lankan students\u2019 dimensions and discourses of professionalism. <i>Medical Education, 51<\/i>(7), 1-14. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Nishigori, H., Harrison, R., Busari, J., &amp; Dornan, T. (2014). Bushido and medical professionalism in Japan. <i>Academic Medicine, 89<\/i>(4), 560\u2013563. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Nishigori, H., Suzuki, T., Matsui, T., Busari, J., &amp; Dornan, T. (2019). A two-edged sword: Narrative inquiry into Japanese doctors\u2019 intrinsic motivation. <i>The Asia Pacific Scholar, 4<\/i>(3), 24-32.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Pan, H., Norris, J. L., Liang, Y., Li, J., &amp; Ho, M. (2013). Building a professionalism framework for healthcare providers in China: A Nominal Group technique study. <i>Medical Teacher, 35<\/i>, e1531\u2013e1536.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Polit, D., &amp; Beck, C. (2006). The content validity index: Are you sure you know what\u2019s being reported? Critique and recommendations. <i>Research in Nursing and Health, 29<\/i>, 489\u2013497.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Powell, C. (2003). The Delphi Technique: Myths and realities &#8211; Methodological issues in nursing research. <i>Journal of Advances in Nursing, 41<\/i>(4), 376\u2013382.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Randolph, J. (n.d.). <i>Online Kappa Calculator<\/i>. Retrieved from <\/span><span lang=\"EN-US\"><a href=\"http:\/\/justusrandolph.net\/kappa\/\"><span lang=\"EN-GB\">http:\/\/justusrandolph.net\/kappa\/<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Schwartz, S. H. (1999). A theory of cultural values and some implications for work. <i>Applied Psychology: An International Review, 48<\/i>(1), 23\u201347.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Sri Lanka Medical Council. (2009). <i>Guidelines on Ethical Conduct for Medical and Dental Practitioners Registered with the Sri Lanka Medical Council<\/i>. Colombo, Sri Lanka: SLMC.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Steinert, Y., Cruess, R. L., Cruess, S. R., Boudreau, J. D., &amp; Fuks, A. (2007). Faculty development as an instrument of change: A case study on teaching professionalism. <i>Academic Medicine, 82<\/i>(11), 1057-1064.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Stern, A. (2006). <i>Measuring Professionalism<\/i>. New York, USA: Oxford University Press.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Susilo, A. P., Marjadi, B., van Dalen, J., &amp; Scherpbier, A. (2019). Patients\u2019 decision-making in the informed consent process in a hierarchical and communal culture. <i>The Asia Pacific Scholar, 4<\/i>(3), 57-66.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Tavakol, M., &amp; Sandars, J. (2014). Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. <i>Medical Teacher, 36<\/i>(10), 838\u2013848.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Uragoda, C. (1987). <i>A History of Medicine in Sri Lanka &#8211; From the Earliest Times to 1948<\/i>. Colombo, Sri Lanka: Sri Lanka Medical Association.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Van de Camp, K., Vernooij-Dassen, M. J. F. J., Grol, R. P. T. M., &amp; Bottema, B. J. A. M. (2004). How to conceptualize professionalism: A qualitative study. <i>Medical Teacher, 26<\/i>(8), 696\u2013702.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Van Mook, W. N. K. A., Van Luijk, S. J., O\u2019Sullivan, H., Wass, V., Schuwirth, L. W., &amp; Van Der Vleuten, C. P. M. (2009). General considerations regarding assessment of professional behaviour. <i>European Journal of Internal Medicine, 20<\/i>(4), e90\u2013e95.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Wear, D., &amp; Kuczewski, M. G. (2004). The professionalism movement: Can we pause? <i>American Journal of Bioethics, 4<\/i>(2), 1\u201310.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Wilkinson, T. J., Wade, W. B., &amp; Knock, L. D. (2009). A blueprint to assess professionalism: Results of a systematic review. <i>Academic Medicine, 84<\/i>(5), 551\u2013558.<\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: justify\"><span lang=\"EN-GB\">Wynia, M. K., Papadakis, M. A., Sullivan, W. M., &amp; Hafferty, F. W. (2014). More than a list of values and desired behaviors: A foundational understanding of medical professionalism. <i>Academic Medicine, 89<\/i>(5), 712\u2013714.<\/span><\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<p align=\"justify\" style=\"text-align: justify\">*Amaya Ellawala<br \/>\r\nDepartment of Medical Education, <br \/>\r\nFaculty of Medical Sciences, <br \/>\r\nUniversity of Sri Jayewardenepura, <br \/>\r\nSri Lanka <br \/>\r\nEmail address: amaya@sjp.ac.lk<\/p>\r\n<\/div>\r\n<ul><\/ul>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":5,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[59],"class_list":["post-1515","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-6-number-1-january-2021"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Using a consensus approach to develop a medical professionalism framework for the Sri Lankan context - 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