experience, but others reported adepletion of their emotionalreserve. On a professional level,trainees were impacted by amedical culture of competencyand competitiveness: they feltpressure to return to work, evenwhen unwell, out of a sense ofduty to colleagues and patients,and out of fear of academicfailure. The phenomenon of stig-ma appeared to be subjectiverather than overt, in some casesinformed by colleagues’ attitudes

towards patients with similarconditions. The perceived stigmawas greatest in trainees withchronic or mental healthconditions. Although traineesrecognised that disclosure wasrequired to gain necessary pro-fessional support, barriers to thisincluded medical culture, stigmaand individual coping styles.

All of these themes related to howtrainees both sought and experi-enced support. Those who were

proactive in disclosing their illnessand seeking assistance were morelikely to receive effective andpractical support, compared withthose who were more passive. Animportant finding of the study wasthat trainees reported a reluctanceto seek pastoral support frommedical or educational supervisorsbecause of perceived repercussionsin training progression.

Although it studied only onedeanery, with self-selectingparticipants, this study providesimportant insights for anyonewho supervises trainee doctors.The implications of this researchinclude the need for improvedtrainee and supervisor awarenessabout the importance of illnessdisclosure and support (as well asthe potential barriers to this), theprovision of pastoral supportseparate from educational super-vision, and a clear organisationalpathway for initiating and moni-toring support that is both effec-tive and practical.

doi: 10.1111/j.1743-498X.2012.00589.x

The status quoofmodernmedical professionalismAndre Dubois and Vinod Patil, Department of Medicine, Queen Mary University of London,UK

Chandratilake M, McAleer S, Gibson J.

Cultural similarities and differences in

medical professionalism: a multi-region

study. Med Educ 2012;46:257–266.

DOI: 10.1111 ⁄ j.1365-2923.

2011.04153.x

Chandratilake and colleagues fromthe University of Dundee exam-ined the essentialness of profes-sional attributes held by medicalpractitioners from differentnational backgrounds.

This study used a questionnaireto ask medical practitioners torate how essential certain attri-butes were to professionalism,using a unipolar scale (a scale of1–5, with 1 being not essentialand 5 being very essential). Thecontent of the questionnaireswas drawn up from attributespublished by medical governingbodies in the UK and USA, withadditions from recent literature

on the subject. A total of fifty-seven were found. These werethen reviewed by an interna-tionally represented group, at ateaching session on how to teachprofessionalism. Forty-six differ-ent attributes were identified,and a further nine non-evidence-based items were added to testthe validity of the evidence-based ones.

It is importantto understandthe attributesthatprofessionalsfrom amulticulturalbackgroundshould expectof one another

� Blackwell Publishing Ltd 2012. THE CLINICAL TEACHER 2012; 9: 265–268 267

The population targeted by thesurvey were postgraduate attend-ees at Dundee University, UK.There were 584 anonymous re-sponses from doctors out of apossible 2057. Although theseincluded responses from aroundthe world, there were too few fromAustralia, Africa or South Americafor meaningful calculations to bemade, and so these were excluded.

Analysis of the data used a con-tent validity index to determine

how essential the attributes were,and an index above 0.78 wasconsidered to be essential. Amulti-rater kappa was used todetermine statistical signifi-cances, with a score above 0.7rated as being significant.

The results were shown to be validwith appropriate discriminationdisplayed by respondents withnone of the non-evidence-basedprofessional attributes being

agreed upon. The results showed a‘core’ of 29 essential attributesthat were agreed upon cross-regionally.

The authors postulated variousreasons for the variation of resultsfrom region to region, includingdifferences in socio-economicfactors in the provision of healthcare, cultural background, theattributes of governing bodies,and their success in instilling theimportance of attributes requiredby those they govern, and theexpectations of society on themedical profession.

Self-appraisal of the author’s workhighlighted that the results mightnot be applicable to professionalsfrom the regions that were notstudied (i.e. Australia, Africa orSouth America). They discussedfurther work looking at differentcultural backgrounds in thoseregions.

Further research in this area isimportant to understand theattributes that professionals froma multicultural background shouldexpect of one another, and oftrainees. In the current financialclimate this concept of ‘Profes-sionalism’ is vital for better team-working and greater efficiency.

doi: 10.1111/j.1743-498X.2012.00608.x

The resultsshowed a ‘core’of 29 essentialattributes that

were agreedupon cross-

regionally

268 � Blackwell Publishing Ltd 2012. THE CLINICAL TEACHER 2012; 9: 265–268