Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990–2019

<b>Introduction:</b> Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed. <b>Methods:</b> Levac’s framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke’s approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism. <b>Results:</b> 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism. <b>Conclusion:</b> Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.

**引言：** 专业素养（Professionalism）是一个不断演变、受社会文化塑造的多维构念，可对医患关系、患者满意度及医疗照护结局产生影响。尽管其在临床实践中具有重要意义，但当前医学学生专业素养的培育方式尚未形成统一标准。为填补这一研究空白，本研究拟开展一项针对医学院校专业素养培育的系统范围综述（systemic scoping review）。
**研究方法：** 本研究以莱瓦克框架（Levac’s framework）与PRISMA-P 2015检查表为研究基础，制定了6阶段系统综述方案。同时采用布朗-克拉克主题分析法（thematic analysis）与定向内容分析法（directed content analysis），以识别专业素养培育的核心要素。
**研究结果：** 本研究从6个数据库中共检索到13921篇摘要，经筛选后对854篇全文文献开展评审，最终纳入162篇合格全文文献。通过主题分析法识别出的4个核心主题，与定向内容分析的结果高度契合，分别为专业素养的定义、培育路径、教学内容以及教学障碍与促进因素。
**研究结论：** 基于合理的专业素养定义与清晰的培养里程碑，专业素养培育应始于契合文化语境的临床能力、人文素养与反思能力培训。该培育过程需对专业身份建构成效与学习环境的影响开展有效评估，这凸显了对整个培育过程进行纵向评估的必要性。