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Byline: SOHAIL S., DAR L.R. and QURESHI F.U.


Background and Objectives: There is need to promote professionalism in junior doctors. The big challenge for medical education is how we can teach and assess professionalism. The objective of the study is to find out - is work place based assessment is a valuable tool to assess professionalism?

Methods: This was a cross sectional study conducted in Gynae/Obs department of Shalamar Medical and Dental college Lahore. Total 50 junior doctor were included in the study. Approval was taken from the ethical committee of hospital. After obtaining informed consent data was collected by direct observation of junior doctors at their place of work during routine working.

Results: 50 junior doctors participated in the study. 25 were house officers and 25 were first year residents. The main traits which were found deficient were empathy in 30%, interpersonal skills in 35% and communication with the patients in 45%.

Conclusion: Work place based assessment is a valuable tool for professionalism. Junior doctors should be assessed at their place of work and feedback provided will help them to identify areas of deficiencies and improvement for future.

Keywords: Professionalism, Assessment, WPBA, Empathy.


One of the great challenges of our health care system is to promote professionalism in our young doctors. Medical professionalism concept is not new It is always considered essential for a doctor. The Hippocratic oath is considered its basis from 400BC.1 There is no agreed definition of the professionalism in literature but certain traits are considered utmost important for the doctor. Medical profession is considered the most noble profession so there will be codes of conduct2. Professionalism affects the quality of health care. Professionalism is the basis of contract of the doctor with the society. Society demands certain values and attributes in a doctor. Desirable professional qualities in a doctor are integrity, honesty, loyalty, empathy, regularity and confidentiality.3

So there is a need that these attributes should be assessed. The commercialization of health care has declined doctors accountability and every other day we listen about doctor patients conflicts.4 So there is need that we work on promotion of professionalism as our professions dignity depends on our commitment with our profession. For inculcating Professionalism it is needed that it should be assessed, deficiencies should be identified and feedback must be given for improvement and to avoid any professional misconduct.

There is no consensus in the world about how we can assess professionalism. Different methods are used in different settings like peer evaluation, patient feedback, 360 degree feedback, work place based assessment, written tests, simulated patients and situations.5

We conducted this study to assess professionalism in our junior doctors by direct observation at workplace. So the objective of this study is to determine is workplace based assessment is a valuable tool for assessment of professionalism.


This was a descriptive observational study carried out in Gynae/Obs department of Shalamar Hospital Lahore from 15november 2015 to15 November 2016. All the house officers who did house job in the department during the study period and first year residents of gynae/obs were included in the study. We excluded post graduate trainees of second, third and fourth year. A proforma was designed in which behaviors like courtesy, flexibility, confidentiality, punctuality, empathy, interpersonal skills, initiative, loyalty, communication skills and utilization of resources were graded as unsatisfactory, satisfactory, good and excellent after direct observation of doctor in a workplace during the period of study. At the time of joining in the department the doctors were told about above mentioned behaviors and it was informed to them that they will be observed throughout their training and these traits will be observed in them.

This evaluation is based on three months of individual observation by two senior doctors at different situations. To eliminate bias each junior doctor was assessed independently by both senior doctors.


Total 50 junior doctors were included in the study. All were females and age of the participants ranged between 24 to 30 years with the mean of 26.5 years.25 doctors were doing house job in gynae/obs department and 25 were post graduate first year residents of gynae/obs. in the same hospital.

Table 1 showed the results of the behaviors which were assessed.

The unsatisfactory behavior detected are presented in the form of graph 1.

The main unsatisfactory behavior identified were lack of empathy, collaboration with others and communication with patients.

Table 1:

No.###Competency Assessed###Unsatisfactory###Satisfactory###Good###Excellent


2.###Flexibility (able to adjust with Change)###25%###25%###32.5%###17.5%




6.###Interpersonal Skills (Cooperation with other)###35%###27.5%###25%###12.5 %



9.###Communication with patients###45%###30%###15%###10%

10.###Utilization of resources###12.5%###55%###20%###12.5%


Professionalism is the demonstration of ethical and moral behavior appropriate for the profession. It is the integral part of commitment and professional development. It is our duty to promote professionalism in our future doctors and help them to attain high professional standards.6 The area of concern is how to assess professionalism as just giving list of items to the junior doctors about required traits or behaviors is not enough. There are increasing trends in medical profession worldwide to gather evidence about doctor performance in their actual clinical setting and environment.7 It is more important what doctors actually do than what they know. By using work-place based assessment we can directly observe the professional behaviors.8,9 In our study we also observed the junior doctors at their place of work. Literature supports that work-place based assessment is a feasible tool to get information about doctor.10

Work-place based assessment should be by multiple independent observers to have more reliable results.11 In our study we also did the assessment of a doctor by two different observers independently to eliminate bias. Evidence from literature suggest that work-place based assessment is helpful to identify the areas of weakness and feedback help the doctor to change the behavior. The behaviors which we have assessed in our study are courtesy, flexibility, confidentiality, punctuality, empathy, interpersonal skills, initiative, loyalty, communication with the patients and utilization of resources. The accredation councils for graduate medical education (ACGME) recommends that residency program to evaluate trainees under six core competencies which are patient care, medical knowledge, practice based learning and improvement interpersonal and communication skills, professionalism and system based care.11,12

In our study we found that empathy, communication with patients and interpersonal skills that is co-operation with others are the main areas of deficiency in our junior doctors. A study conducted in Poland in 509 participants also concluded that empathy is declining in our medical students and urgent need of educational programs to reinforce this trait.13,14

A study was conducted in China showed that improved communication skills has a strong influence on improving doctor patient relation-ship.15A systematic review by Kelm Z and Womer J also revealed empathy is an important aspect of physician patient relationship and it is declining.16

A study done in two teaching hospitals of Ireland showed that poor teamwork between doctors and nurses is common and places patient at great risk.17 Literature suggest that conflicts with colleagues are increasing and are the area of concern.18

Communication with the patients is very important as lack of proper communication leads to conflicts and medical litigation.

Patients comply more with the doctor who show concern with them. 19,20

It is concluded that work-place assessment is a valuable tool for assessment of professionalism and it is important to identify the area of deficiencies in our junior doctors and give them feedback to improve. Programs should be introduced for the junior doctors to improve, Empathy, teamwork, communication with the patients.

We recommend that junior doctors should be regularly assessed for professionalism at their workplace and it should be the integral part of their training program.


We are thankful to the senior registrars for helping in work place based assessment of junior doctors. We acknowledge the work of Mr. Zubair in presenting the data in the form of graphs.

Conflict of Interest

All authors report no conflict of interest.

Authors' Contributions

SS designed the research proposal, collected data, did the literature search and wrote manuscript. LRD helped in data collection and did the review of manuscript and helped in finalizing the article FU helped in reviewing the article.


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Date:Mar 31, 2017
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