COMPARATIVE STUDY OF PROFESSIONALISM OF FUTURE MEDICAL PROFESSIONALS AMONG THREE PRIVATE MEDICAL COLLEGES OF BANGLADESH
Objectives: Medical professionalism forms the bridge between doctors and society. Conserving and maintaining professionalism is obligatory for physician curriculum. The objective of this study was to scrutinize and compare the professionalism of future medical professionals among different medical institutes.
Methodology: It was a cross-sectional study conducted on 332 year-III and year-IV MBBS students of session 2012-2013 from three private medical colleges in Bangladesh. Data was collected using a mixed validated instrument containing items under fundamental elements of professionalism, measured by 5-points Likert scale giving a maximum score of 220.
Results: Among 332 respondents, 44% were male, 56% female; Year-III respondents constituted 51% and Year-IV constituted 49%. Mean professionalism scores for male and female were 176.21 and 175.33, while for Year-III and Year-IV were 174.96 and 176.50 respectively. No significant differences observed between gender and year of study. However, significant differences were noticed between year-IV male students among three medical colleges. Majority (83%) students were imprecise of professionalism.
Conclusions: Lack of focus is a worry for professionalism. Educators should focus on fundamental elements of professionalism.
KEYWORDS: Professionalism, Medical-student, Core-values, Comparisons, Bangladesh.
2. Noordegraaf M. From "Pure" to "Hybrid" Professionalism: Present-Day Professionalism in Ambiguous Public Domains. Adm Soc 2007; 39 (6): 761-85. http://dx.doi.org/10.1177/0095399707304434 (Accessed on 01/03/2013)
3. Irvine D. Doctors in the UK: their new professionalism and its regulatory framework. Lancet 2001; 358 (9295): 1807-10. http://dx.doi.org/10.1016/S0140-6736(01)06800-3 (Accessed on 03/03/2013)
4. Cruess RL, Cruess SR, Johnston SE. Professionalism: an ideal to be sustained. Lancet 2000; 356 (9224): 156-59. http://dx.doi.org/10.1016/S0140-6736(00)02458-2 (Accessed on 02/03/2013)
5. Irvine D. The performance of doctors. i: professionalism and self regulation in a changing world. BMJ 1997; 314 (7093): 1540-42. http://dx.doi.org/10.1136/bmj.314.7093.1540 (Accessed on 04/03/2013)
6. Lynch DC, Surdyk PM, Eiser AR. Assessing professionalism: a review of the literature. Med Teach 2004; 26 (4): 366-73. http://dx.doi.org/10.1080/01421590410001696434 (Accessed on 01/04/2013)
7. Holtman MC. Paradoxes of professionalism and error in complex systems. J Biomed Inform 2011; 44 (3): 395-401. http://dx.doi.org/10.1016/j.jbi.2009.08.002 (Accessed on 10/03/2013)
8. Woolf AD. How to achieve and enhance professionalism in rheumatology. Best Pract Res Clin Rheumatol 2009; 23 (2): 127-44. http://dx.doi.org/10.1016/j.berh.2009.03.002 (Accessed on 11/03/2013)
9. ACGME. ACGME outcome project. Available from: http://www.acgme.org/Outcome/ (Accessed on 31/03/2013)
10. Swing RS. The ACGME outcome project: retrospective and prospective. Med Teach 2007; 29 (7): 648-54. http://dx.doi.org/10.1080/01421590701392903 (Accessed on 3/03/2013)
11. Irvine D. The Doctorâ€™s Tale. Oxford: Radcliffe Medical Press, 2003.
12. Hilton SR, Slotnick HB. Proto-professionalism: how professionalism occurs across the continuum of medical education. Med Educ 2005; 39 (1): 58-65. http://dx.doi.org/10.1111/j.1365-2929.2004.02033.x (Accessed on 01/03/2013)
13. Santen SA and Hemphill RR. A window on professionalism in the emergency department through medical student narratives. Ann Emerg Med 2011; 58(3): 288-94. http://dx.doi.org/10.1016/j.annemergmed.2011.04.001 Epub 2011 May 31. (Accessed on 03/03/2013)
14. Adams J, Schmidt T, Sanders A, Larkin GL, Knopp R. Professionalism in emergency medicine. SAEM Ethics Committee. Society for Academic Emergency Medicine. Acad Emerg Med 1998; 5 (12): 1193-9. http://dx.doi.org/10.1111/j.1553-2712.1998.tb02695.x (Accessed on 28/02/2013)
15. Cruess SR and Cruess RL. Professionalism must be taught. BMJ 1997; 315 (123): 1674-7. http://dx.doi.org/10.1136/bmj.315.7123.1674 (Accessed on 02/03/2013)
16. Relman AS. Education to defend professional values in the new corporate age. Acad Med 1998; 73 (12): 1229-33. http://dx.doi.org/10.1097/00001888-199812000-00010 (Accessed on 02/03/2013)
17. Arnold L and Stern DT. What is Medical Professionalism? In: Measuring Medical Professionalism. Sten DT eds. New York 10016, USA. Oxford University Press, 2006, pp 15-38.
18. Sullivan WM. Medicine under threat: professionalism and professional identity. CMAJ 2000; 162 (5): 673-5.
19. Cruess SR and Cruess RL. Professionalism: a contract between medicine and society. CMAJ 2000; 162 (5): 668-9.
20. Chiu CH, Lu HY, Arrigo LG, Wei CJ, Tsai D. A Professionalism Survey of Medical Students in Taiwan. J Exp Clin Med 2010; 2 (1): 35-42. http://dx.doi.org/10.1016/S1878-3317(10)60006-X (Accessed on 10/03/2013 )
21. Cohen JJ. Leadership for medicineâ€™s promising future. Acad Med 1998; 73 (2): 132-7.
22. MSOP Writing Group. Learning objectives for medical student education--guidelines for medical schools: report I of the Medical School Objectives Project. Acad Med 1999; 74 (1): 13-8. http://dx.doi.org/10.1097/00001888-199901000-00010 (Accessed on 11/3/2013)
23. Fallat ME, Glover J. Professionalism in pediatrics. Pediatrics 2007; 120 (4): e1123-33. http://dx.doi.org/10.1542/peds.2007-2230 (Accessed on 01/03/2013)
24. Goold SD, Stern DT. Ethics and professionalism: what does a resident need to learn? Am J Bioeth 2006; 6 (4): 9-17. http://dx.doi.org/10.1080/15265160600755409 (Accessed on 01/03/2013)
25. Huddle TS. Viewpoint: teaching professionalism: is medical morality a competency? Acad Med 2005; 80 (10): 885-91. http://dx.doi.org/10.1097/00001888-200510000-00002 (Accessed on 11/3/2013)
26. Saultz JW. Are we serious about teaching professionalism in medicine? Acad Med 2007; 82 (6): 574-7. http://dx.doi.org/10.1097/ACM.0b013e3180555c5f
27. Whitcomb ME. Medical professionalism: can it be taught? Acad Med 2005; 80 (10): 883-4. http://dx.doi.org/10.1097/00001888-200510000-00001 (Accessed on 10/03/2013)
28. Larkin GL, Binder L, Houry D, Adams J. Defining and evaluating professionalism: a core competency for graduate emergency medical education. Acad Emerg Med 2002; 9 (11): 1249-56. http://dx.doi.org/10.1111/j.1553-2712.2002.tb01585.x (Accessed on 11/03/2013)
29. Ponnamperuma GG, Ker JS, Davis MH. Medical professionalism: teaching, learning, and assessment. South East Asian Journal of Medical Education. Inaugural Issue. 2007; 1 (1): 42-48.
30. Marco CA, Lu DW, Stettner E, Sokolove PE, Ufberg JW, Noeller TP. Ethics curriculum for emergency medicine graduate medical education. J Emerg Med 2011; 40 (5): 550-6. http://dx.doi.org/10.1016/j.jemermed.2010.05.076 Epub 2010 Oct 2. (Accessed on 10/04/2013)
31. Hafferty FW, Castellani B. The increasing complexities of professionalism. Acad Med 2010; 85 (2): 288-301. http://dx.doi.org/10.1097/ACM.0b013e3181c85b43 (Accessed on 11/03/2013)
32. Kesselheim JC, Sectish TC, Joffe S. Education in professionalism: results from a survey of pediatric residency program directors. J Grad Med Educ 2012; 4 (1): 101-5. http://dx.doi.org/10.4300/JGME-D-11-00110.1 (Accessed on 10/04/2013)
33. Emanuel LL. Deriving professionalism from its roots. Am J Bioeth 2004; 4 (2): 17-8. http://dx.doi.org/10.1162/152651604323097655 (Accessed on 11/04/2013)
34. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002; 287 (2): 226-35. http://dx.doi.org/10.1001/jama.287.2.226 (Accessed on 1/04/2013)
35. McManus I, Gordon D, Winder B. Duties of a doctor: UK doctors and Good Medical Practice. Qual Health Care 2000; 9 (1): 14-22. http://dx.doi.org/10.1136/qhc.9.1.14 (Accessed on 1/04/2013)
36. Davis DS. Teaching professionalism: A survey of physical therapy educators. J Allied Health 2009; 38 (2): 74-80.
37. Fidler GS. Developing a repertoire of professional behaviours. Am J Occup Ther 1996; 50 (7): 583-7. http://dx.doi.org/10.5014/ajot.50.7.583 (Accessed on 02/04/2013)
38. McDonald C, Houghton P, Cox P, Bartlett D. Consensus on physical therapy professional behaviours. Physiotherapy Canada 2001; 53: 212-8.
39. McNair RP. The case for educating health care students in professionalism as the core content of interprofessional education. Med Educ 2005; 39 (5): 456-64. http://dx.doi.org/10.1111/j.1365-2929.2005.02116.x (Accessed on 10/04/2013)
40. Hafferty FW. Professionalismâ€“the next wave. N Engl J Med 2006; 355 (20): 2151-2. http://dx.doi.org/10.1056/NEJMe068217 Epub 2006 Oct 25. (Accessed on 11/04/2013)
41. American College of Surgeons. Code of Professional Conduct. 2003. Available at: http://www.facs.org/membersservices/codeofconduct.html (Accessed 02/04/2013)
42. Canadian Medical Association. CMA Code of Ethics. 2004. Available at http://www.policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf (Accessed 14/04/2013)
43. Blumenthal D. The vital role of professionalism in health care reform. Health Aff 1994; 13 (1): 252-6. http://dx.doi.org/10.1377/hlthaff.13.1.252 (Accessed on 1/03/2013)
44. Hensel WA, Dickey NW. Teaching professionalism: passing the torch. Acad Med 1998; 73 (8): 865-70. http://dx.doi.org/10.1097/00001888-199808000-00011 (Accessed on 15/03/2013)
45. Reynolds PP. Reaffirming professionalism through the education community. Ann Intern Med 1996; 120 (7): 609-14. http://dx.doi.org/10.7326/0003-4819-120-7-199404010-00013 (Accessed on 17/03/2013)
46. Swick HM. Academic medicine must deal with the clash of business and professional values. Acad Med 1998; 73 (7): 751-5. http://dx.doi.org/10.1097/00001888-199807000-00010 (Accessed on 15/02/2013)
47. Swick HM, Simpson DE, Van Susteren TJ. Fostering the professional development of medical students. Teach Learn Med 1995; 7 (1): 55-60. http://dx.doi.org/10.1080/10401339509539711 (Accessed on 15/02/2013)
48. Wynia MK, Latham SR, Kao AC, Berg JW, Emanuel LL. Medical professionalism in society. N Engl J Med 1999; 341 (21): 1612-6. http://dx.doi.org/10.1056/NEJM199911183412112 (Accessed on 15/02/2013)
49. Association of American Medical Colleges. Professionalism in Contemporary Medical Education: An Invitational Colloquium. Washington, DC: Association of American Medical Colleges, 1998.
50. Riley S and Kumar N. Teaching medical professionalism. Clin Med 2012; 12 (1): 9-11. http://dx.doi.org/10.7861/clinmedicine.12-1-9 (Accessed on 15/02/2013)
51. Robinson AJ, Tanchuk CJ, Sullivan TM. Profession and occupational therapy: An exploration of faculty and studentsâ€™ perspective. Can J Occup Ther 2012; 79 (5): 275-84.
52. Rosen R and Dewar S. On Being a Doctor: Redefining Medical Professionalism for Better Patient Care. London: King's Fund; 2004.
53. van Mook WN, van Luijk SJ, O'Sullivan H, Wass V, Zwaveling JH, Schuwirth LW, et al. The concepts of professionalism and professional behaviour: conflicts in both definition and learning outcomes. Eur J Intern Med 2009; 20 (4): e85-9. http://dx.doi.org/10.1016/j.ejim.2008.10.006 (Accessed on 15/02/2013)
54. Erde EL. Professionalism's facets: ambiguity, ambivalence, and nostalgia. J Med Philos 2008; 33 (1): 6-26. http://dx.doi.org/10.1093/jmp/jhm003 (Accessed on 11/03/2013)
55. Jones L, Green J. Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom. Sociol Health Illn 2006; 28 (7): 927-50. http://dx.doi.org/10.1111/j.1467-9566.2006.00513.x (Accessed on 05/03/2013)
56. Ginsburg S, Regehr G, Hatala R, McNaughton N, Frohna A, Hodges B, et al. Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med 2000; 75 (10 Suppl): S6â€“11. http://dx.doi.org/10.1097/00001888-200010001-00003 (Accessed on 05/03/2013)
57. Bryden P, Ginsburg S, Kurabi B, Ahmed N. Professing professionalism: Are we our own worst enemy? Faculty membersâ€™ experiences of teaching and evaluating professionalism in medical education at one school. Acad Med 2010; 85 (6): 1025-34. http://dx.doi.org/10.1097/ACM.0b013e3181ce64ae (Accessed on 11/04/2013)
58. McLachlan J. Measuring conscientiousness and professionalism in undergraduate medical students. Clin Teach 2010; 7 (1): 37-40. http://dx.doi.org/10.1111/j/1743-498X.2009.00338.x (Accessed on 11/04/2013)
59. Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000; 75 (6): 612-6. http://dx.doi.org/10.1097/00001888-200006000-00010 (Accessed on 11/04/2013)
60. Fox E, Arnold RM, Brody B. Medical ethics education: past, present, and future. Acad Med 1995; 70 (9): 761-9. http://dx.doi.org/10.1097/00001888-199509000-00011 (Accessed on 11/04/2013)
61. Muller S. Physicians for the Twenty-First Century. Report of the project panel on the general professional education of the physician and college preparation for medicine. J Med Educ 1984; 59 (11 Pt 2): 1-208.
62. Gillon R. Medical ethics education. J Med Ethics 1987; 13 (3): 115-6. http://dx.doi.org/10.1136/jme.13.3.115 (Accessed on 07/03/2013)
63. Association of the Faculties of Medicine of Canada. The future of medical education in Canada: a collective vision for MD education. Ottawa, ON: Association of the Faculties of Medicine of Canada; 2010. Available from: www.afmc.ca/fmec/pdf/collective_vision.pdf. (Accessed 02/03/2013).
64. Liaison Committee on Medical Education. Functions and structure of a medical school: LCME accreditation standards. Chicago, IL: Liaison Committee on Medical Education; 2012. Available from: www.lcme.org/standard.htm. (Accessed 02/03/2013).
65. Royal College of Physicians and Surgeons of Canada. Accreditation Committee discussion paper: biomedical ethics. Ottawa, IN: Royal College of Physicians and Surgeons of Canada; 1994.
66. Mueller PS. Incorporating Professionalism into Medical Education: The Mayo Clinic Experience. Keio J Med 2009; 58 (3): 133-43. http://dx.doi.org/10.2302/kjm.58.133 (Accessed on 11/03/2013)
67. van Mook WN, de Grave WS, Wass V, O'Sullivan H, Zwaveling JH, Schuwirth LW, et al. Professionalism: evolution of the concept. Eur J Intern Med. 2009; 20 (4): e81â€“4. http://dx.doi.org/10.1016/j.ejim.2008.10.005 (Accessed on 01/04/2013)
68. Southon G, Braithwaite J. The end of professionalism? Soc Sci Med 1998; 46 (1): 23â€“8. http://dx.doi.org/10.1016/S0277-9536(97)00131-7 (Accessed on 11/04/2013)
69. Levenson R, Dewar S, Shepherd S. Understanding Doctors: Harnessing Professionalism. London: King's Fund; 2008.
70. Medical Professionalism Project. Medical professionalism in the new millennium: a physicians' charter. Lancet 2002; 359 (9305): 520â€“2. http://dx.doi.org/10.1016/S0140-6736(02)07684-5 (Accessed on 11/04/2013)
71. Royal College of Physicians. Doctors in Society: Medical Professionalism in a Changing World. London: Royal College of Physicians; 2005.
72. American Board of Internal Medicine. Project Professionalism. Philadelphia, Pennsylvania: American Board of Internal Medicine; 1995.
73. Ludmerer KM. Instilling Professionalism in Medical Education. JAMA 1999; 282 (9): 881-2. http://dx.doi.org/10.1001/jama.282.9.881 Downloaded From: http://jama.jamanetwork.com/ by a UNIVERSITI SULTAN ZAINAL ABIDIN (Accessed on 02/26/2013)
74. Smith R. Medical professionalism: out with the old and in with the new. J R Soc Med 2006; 99 (2): 48â€“50. http://dx.doi.org/10.1258/jrsm.99.2.48 (Accessed on 11/04/2013)
75. Streatfield PK and Karar ZA. Population Challenges for Bangladesh in the Coming Decades. J Health Popul Nutr 2008; 26 (3): 261-72. http://dx.doi.org/10.3329/jhpn.v26i3.1894 (Accessed on 11/04/2013)
76. CIA. Central Intelligence Agency. The World Factbook. Available from: http://www.cia.gov/cia/publications/factbook/geos/bg.html. (Accessed 03/02/2013).
77. Haque M and Rao USM. Appraisal on Bangladeshi Medical Didactic approaches, Implementation of Reread Medical Education Curriculum Design, and Suggesting Pharmacology and Therapeutics Discipline throughout the Clinical Years of Graduation epoch. Research J Pharm and Tech 2012; 5(11): 1428-32.
78. Schwartz S, Griffin T. Medical Thinking: The Psychology of Medical Judgment and Rational Decision Making. New York. Springer: 1986.
79. World Health Organisation. Developing Learning Materials on Rational Use of Drugs for Medical and Nursing Schools: Report of an Intercountry Workshop. Bangkok, Thailand, 1993. http://whqlibdoc.who.int/searo/1985-93/HLT_35.pdf (Accessed on 11/04/2013)
80. Ramsay LE. Bridging the Gap between Clinical Pharmacology and Rational Drug Prescribing. Br J Clin Pharmacol 1993; 35 (6): 575-6. http://dx.doi.org/10.1111/j.1365-2125.1993.tb04183.x (Accessed on 01/04/2013)
81. De Vries TP. Presenting Clinical Pharmacology and Therapeutics: General Introduction. Br J Clin Pharmacol 1993; 35 (6): 577-9.
82. Begum M, Rahman MS, Islam AFM, Khan IA, Akter N. Eleven Years of the Undergraduate Medical Curriculum 1988: Review on the Changes in Pharmacology Written Questions. Bang J Physiol Pharmacol 1999; 15 (1): 27-30.
83. Rahman MS, Kamal ASMK, Choudhury S, Khan IA, Islam AMZ, Sultana R, Begum M, Akter N, Anwar AKMN. Exercise on selection of P-drug: Preliminary Evaluation of a Newer Method of Pharmacology Teaching in Bangladesh. Bang J Physiol Pharmacol 2000; 16 (2): 50-4.
84. Bodenheimer T. Uneasy alliance: clinical investigators and the pharmaceutical industry. N Engl J Med 2000; 342 (20): 1539-44. http://dx.doi.org/10.1056/NEJM200005183422024 (Accessed on 01/04/2013)
85. Relman AS. Separating continuing medical education from pharmaceutical marketing. JAMA 2001; 285 (15): 2009-12. http://dx.doi.org/10.1001/jama.285.15.2009 (Accessed on 11/03/2013)
86. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research. JAMA 2003; 289 (4): 454-65. http://dx.doi.org/10.1001/jama.289.4.454 (Accessed on 11/03/2013)
87. Studdert DM, Mello MM, Brennan TA. Financial conflicts of interest in physiciansâ€™ relationships with the pharmaceutical industryâ€”self-regulation in the shadow of federal prosecution. N Engl J Med 2004; 351 (18): 1891-900. http://dx.doi.org/10.1056/NEJMlim042229 (Accessed on 11/04/2013)
88. Blumenthal D. Doctors and drug companies. N Engl J Med 2004; 351 (18): 1885-90. http://dx.doi.org/10.1056/NEJMhpr042734 (Accessed on 01/04/2013)
89. Brodkey AC. The role of the pharmaceutical industry in teaching psychopharmacology: a growing problem. Acad Psychiatry 2005; 29 (2): 222-9. http://dx.doi.org/10.1176/appi.ap.29.2.222 (Accessed on 01/04/2013)
90. Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982; 73 (1): 4-8. http://dx.doi.org/10.1016/0002-9343(82)90911-1 (Accessed on 11/03/2013)
91. Bobbio M, Demichelis B, Giustetto G. Completeness of reporting trial results: effect on physicians' willingness to prescribe. Lancet 1994; 343 (8907): 1209-11. http://dx.doi.org/10.1016/S0140-6736(94)92407-4 (Accessed on 15/04/2013)
92. Sufrin CB, Ross JS. Pharmaceutical industry marketing: understanding its impact on women's health. Obstet Gynecol Surv 2008; 63 (9): 585-96. http://dx.doi.org/10.1097/OGX.0b013e31817f1585 (Accessed on 15/04/2013)
93. Pharmaceutical Research and Manufacturers of America. Appendix: detailed results from the annual survey. In: Pharmaceutical Industry Profile, 2001.Washington, DC: PhRMA; 2001: Table 18.
94. Accreditation Council for Continuing Medical Education. ACCME annual report data 2011. Available at: http://www.cohealthcom.org/wp-content/uploads/2012/07/ACCME-Annual-Report.pdf (Accessed 04/04/2013).
95. Bowman MA. The impact of Drug Company funding on the content of continuing medical education. J Contin Educ Health Prof 1986; 6 (1): 66-9. http://dx.doi.org/10.1002/chp.4760060112 (Accessed on 11/04/2013)
96. Ziegler MG, Lew P, Singer BC. The accuracy of drug information from pharmaceutical sales representatives. JAMA 1995; 273 (16): 1296-8. http://dx.doi.org/10.1001/jama.273.16.1296 (Accessed on 17/04/2013)
97. Bero LA, Rennie D. Influences on the quality of published drug studies. Int J Technol Assess Health Care 1996; 12 (2): 209-37. http://dx.doi.org/10.1017/S0266462300009582 (Accessed on 01/03/2013)
98. Cho MK, Bero LA. The quality of drug studies published in symposium proceedings. Ann Intern Med 1996; 124 (5): 485-9. http://dx.doi.org/10.7326/0003-4819-124-5-199603010-00004 (Accessed on 07/04/2013)
99. Spingarn RW, Berlin JA, Strom BL. When pharmaceutical manufacturersâ€™ employees present grand rounds, what do residents remember? Acad Med 1996; 71 (1): 86-8.
100. Stryer D, Bero LA. Characteristics of materials distributed by drug companies. An evaluation of appropriateness. J Gen Intern Med 1996; 11 (10): 575-83. http://dx.doi.org/10.1007/BF02599024 (Accessed 01/03/2013)
101. Schulman KA, Seils DM, Timbie JW, Sugarman J, Dame LA, Weinfurt KP, et al. A national survey of provisions in clinical trial agreements between medical schools and industry sponsors. N Engl J Med 2002; 347 (17): 1335-41. http://dx.doi.org/10.1056/NEJMsa020349 (Accessed on 03/03/2013)
102. Villanueva P, Peiro S, Librero J, Pereiro I. Accuracy of pharmaceutical advertisements in medical journals. Lancet 2003; 361 (9351): 27-32. http://dx.doi.org/10.1016/S0140-6736(03)12118-6 (Accessed on 05/03/2013)
103. Bowman MA, Pearle DL. Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Contin Educ Health Prof 1988; 8 (1): 13-20. http://dx.doi.org/10.1002/chp.4750080104 (Accessed on 05/03/2013)
104. Orlowski JP, Wateska L. The effects of pharmaceutical firm enticements on physician prescribing patterns. Thereâ€™s no such thing as a free lunch. Chest 1992; 102 (1): 270-3. http://dx.doi.org/10.1378/chest.102.1.270 (Accessed on 05/03/2013)
105. Chren MM, Landefeld CS. Physiciansâ€™ behavior and their interactions with drug companies: a controlled study of physicians who requested additions to a hospital drug formulary. JAMA 1994; 271 (9): 684-9. http://dx.doi.org/10.1001/jama.271.9.684 (Accessed on 07/03/2013)
106. Prosser H, Almond S, Walley T. Influences on GPsâ€™ decisions to prescribe new drugs- the importance of who says what. Fam Pract 2003; 20 (1): 61-8. http://dx.doi.org/10.1093/fampra/20.1.61 (Accessed on 07/03/2013)
107. Rahman MS, Begum M, Haque MZ, Akhter N. Drug Advertisement in Medical Journals: A Commentary. Bang J Physiol Pharmacol 1999; 15 (1): 31-36
108. Siegel D, Lopez J. Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing? JAMA 1997; 278 (21): 1745-8. http://dx.doi.org/10.1001/jama.278.21.1745 (Accessed on 07/03/2013)
109. Schneeweiss S, Glynn RJ, Avorn J, Solomon DH. A Medicare data base review found that physician preferences increasingly outweighed patient characteristics as determinants of first-time prescriptions for COX-2 inhibitors. J Clin Epidemiol 2005; 58 (1): 98-102.
110. Kousalya K, Chirumamilla S, Smanjunath S, Ramalakshmi S, Saranya P, Chamundeeswari D. Prescribing trend of antihypertensive drugs in hypertensive and diabetic hypertensive patients. Asian J Pharm Clin Res 2012; 5 (4): 22-23. Available at http://www.ajpcr.com/Vol5Issue4/735.pdf (Accessed on 22/05/2013)
111. Chew LD, Oâ€™Young TS, Hazlet TK, Bradley KA, Maynard C, Lessler DS. A physician survey of the effect of drug sample availability on physiciansâ€™ behavior. J Gen Intern Med 2000; 15 (7): 478-83. http://dx.doi.org/10.1046/j.1525-1497.2000.08014.x (Accessed on 05/03/2013)
112. Mintzes B, Barer ML, Kravitz RL, Bassett K, Lexchin J, Kazanjian A, et al. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. CMAJ 2003; 169 (5): 405-12.
113. Rajanandh MG, Ramasamy C, Khan IA. Pattern of Cardiovascular Drugs Use In Outpatients in a Tertiary Care Hospital. Asian J Pharm Clin Res 2012; 5(1): 109-12. Available at http://www.ajpcr.com/Vol5Issue1/723.pdf (Accessed on 22/05/2013)
114. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000; 283 (3): 373-80. http://dx.doi.org/10.1001/jama.283.3.373 (Accessed on 05/03/2013)
115. Haayer F. Rational prescribing and sources of information. Soc Sci Med 1982; 16 (23): 2017-23. http://dx.doi.org/10.1016/0277-9536(82)90158-7 (Accessed on 06/03/2013)
116. Caudill TS, Johnson MS, Rich EC, McKinney WP. Physicians, pharmaceutical sales representatives and the cost of prescribing. Arch Fam Med 1996; 5 (4): 201-6. http://dx.doi.org/10.1001/archfami.5.4.201 (Accessed on 09/03/2013)
117. Bower AD, Burkett GL. Family physicians and generic drugs: a study of recognition, information sources, prescribing attitudes, and practices. J Fam Pract 1987; 24 (6): 612-6.
118. Rahman Z, Nazneen R and Begum M. Evaluation of prescribing pattern of the private practitioners by the undergraduate medical students. Bangladesh J Pharmacol 2009; 4 (1): 73-5. http://dx.doi.org/10.3329/bjp.v4i1.1583
119. Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002; 287 (5): 612-7. http://dx.doi.org/10.1001/jama.287.5.612 (Accessed on 09/03/2013)
120. McKinney WP, Schiedermayer DL, Lurie N, Simpson DE, Goodman JL, Rich EC. Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA 1990; 264 (13): 1693-7. http://dx.doi.org/10.1001/jama.264.13.1693 (Accessed on 15/03/2013)
121. Banks JW III, Mainous AG III. Attitudes of medical school faculty toward gifts from the pharmaceutical industry. Acad Med 1992; 67 (9): 610-2. http://dx.doi.org/10.1097/00001888-199209000-00017 (Accessed on 01/03/2013)
122. Reeder M, Dougherty J, White LJ. Pharmaceutical representatives and emergency medicine residents: a national survey. Ann Emerg Med 1993; 22 (10): 1593-6. http://dx.doi.org/10.1016/S0196-0644(05)81266-1 (Accessed on 07/03/2013)
123. Hodges B. Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks. CMAJ 1995; 153 (5): 553-9.
124. Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine house staff toward pharmaceutical industry promotions. Am J Med 2001; 110 (7): 551-7.
125. Bosch X, Ross JS. Ghostwriting: research misconduct, plagiarism, or foolâ€™s gold? Am J Med 2012; 125 (4): 324-6. http://dx.doi.org/10.1016/j.amjmed.2011.07.015. (Accessed on 11/04/2013)
126. Bosch X, Esfandiari B, McHenry L. Challenging Medical Ghostwriting in US Courts. PLoS Med 2012; 9 (1): e1001163, 1-4. http://dx.doi.org/10.1371/journal.pmed.1001163. (Accessed on 11/04/2013)
127. Swick HM, Szenas P, Danoff D, Whitcomb ME. Teaching Professionalism in undergraduate medical education. JAMA 1999; 282 (9): 830-2. http://dx.doi.org/10.1001/jama.282.9.830 (Accessed on 05/04/2013)
128. Stern DT, Papadakis M. The developing physicians-becoming a professional. N Engl J Med 2006; 355 (17): 1794-99.
129. Centre for Medical Education. Curriculum for Under-graduate Medical Education in Bangladesh 2002. Mohakhali, Dhaka 1212, Bangladesh.
130. Salam A, Song CO, Mazlan NF, Lee LS, Abdullah MA, Hassin H. Professionalism of Future Medical Professionals in Universiti Kebangsaan Malaysia (UKM) Medical Centre. International Medical Journal 2012a; 19: 224-28.
131. Salam A, Song CO, Mazlan NF, Hassin H, Lee LS, Abdullah MH. A pilot study on professionalism of future medical professionals in Universiti Kebangsaan Malaysia (UKM) Medical Centre. Procedia - Social and Behavioral Sciences 2012b; 60: 534-40. http://dx.doi.org/10.1016/j.sbspro.2012.09.419 (Accessed on 02/02/2013)
132. Hultman CS, Connolly A, Halvorson EG, Rowland P, Meyers MO, Mayer DC, et al. Get on your boots: Preparing forth-year medical students for a career in surgery, using a focused curriculum to teach the competency of professionalism. J Surg Res 2012; 177 (2): 217-23. http://dx.doi.org/10.1016/j.jss.2012.06.019 (Accessed on 05/04/2013)
133. Khaliq AA, Dimassi H, Huang CY, Narine L, Smego RA Jr. Disciplinary action against physicians: Who is likely to get disciplined? Am J Med 2005; 118 (7): 773-7. http://dx.doi.org/10.1016/j.amjmed.2005.01.051 (Accessed on 05/04/2013)
134. Branch WT Jr. The road to professionalism: Reflective practice and reflective learning. Patient Educ Couns 2010; 80 (3): 327-32. http://dx.doi.org/10.1016/j.pec.2010.04.022
135. Evaluation of humanistic qualities in the internist. Ann Intern Med 1983; 99 (5): 720-24.
136. Salam A, Yousuf R, Islam MZ, Yesmin F, Helali AM, Alattraqchi AG, Rao USM and Haque M. Professionalism of future medical professionals in Universiti Sultan Zainal Abidin, Malaysia. Bangladesh J Pharmacol 2013; 8 (2): 124-30
137. Nath C, Schmidt R, Gunel E. Perceptions of professionalism vary most with educational rank and age. J Dent Educ 2006; 70 (8): 825-34.
138. Cruess RL, Cruess SR, Steinert Y. Teaching Medical Professionalism. Print Publication Press, 2008.
139. Caughey JL Jr. Medical Education Based On Interdepartmental Cooperation. JAMA 1956; 161 (8): 697-9. http://dx.doi.org/10.1001/jama.1956.02970080027009 (Accessed on 10/04/2013)
140. Ham TH. The Approaches of the Faculty to Medical Education at Western Reserve University. J Med Educ 1959; 34 (12): 1163-74.
141. Salam A, Ghafar AA, Latif HA, Siraj HH, Mahdy ZA, Zakaria SZS, et al. Synchronous transnational collaborative learning: An interesting model of education to learn medicine in global perspectives. South East Asia Journal of Public Health 2011; 1 (1): 59-63. http://dx.doi.org/10.3329/seajph.v1i1.13222 (Accessed on 05/04/2013)
142. Brown D, Ferrill MJ, Lloyd L. The taxonomy of professionalism: reframing the academic pursuit of professional development. Am J Pharm Educ 2009; 73 (4): 68. http://dx.doi.org/10.5688/aj730468
143. Duke LJ, Kennedy K, McDuffie CH, Miller MS. Sheffield MC, Chisholm MA. Student attitudes, values and beliefs regarding professionalism. Am J Pharm Educ 2005; 69 (5): 104-11. http://dx.doi.org/10.5688/aj6905104 (Accessed on 10/04/2013)
144. Wynia MK. The short history and tenuous future of medical professionalism: the erosion of medicine's social contract. Perspect Biol Med 2008; 51 (4): 565-78. http://dx.doi.org/10.1353/pbm.0.0051. (Accessed on 02/02/2013)
145. WFEM Executive Council. Continuing Professional Development (CPD) of Medical Doctors WFME Global Standards. WFME Office: University of Copenhagen â€¢ Denmark. 2003
146. Salam A, Mohammad N, Besar MNA. Audit Upon Graduation: UKM House Officersâ€™ Competencies. Procedia Social and Behavioral Sciences 2011; 18: 460-3. http://dx.doi.org/10.1016/j.sbspro.2011.05.067 (Accessed on 01/02/2013)
147. Nabishah M, Farihah HS, Das S, Salam A, Siti Marium B, Mohd Arif K, Harlina HS, & Wan Zurinah WN. Problem based learning facilitation: new challenges to higher education educators. Int Med J 2009; 16: 243-6.
148. Wright SM, Kern DE, Kolodner K, Howard DM, Brancati, FL. Attributes of Excellent Attending-Physician Role Models. N Engl J Med. 1998; 339 (27): 1986-93. http://dx.doi.org/10.1056/NEJM199812313392706 (Accessed on 01/02/2013)
149. Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ 2002; 325 (7366): 707-10. http://dx.doi.org/10.1136/bmj.325.7366.707 (Accessed on 01/02/2013)
150. Yazigi A, Nasr M, Sleilaty G, Nemr E. Clinical teachers as role models: perceptions of interns and residents in a Lebanese medical school. Medical Education 2006; 40 (7): 654â€“1. http://dx.doi.org/10.1111/j.1365-2929.2006.02502.x (Accessed on 01/02/2013)
151. Kenny NP, Mann KV, and MacLeod H. Role Modeling in Physiciansâ€™ Professional Formation: Reconsidering an Essential but Untapped Educational Strategy. Acad Med 2003; 78 (12): 1203â€“10. http://dx.doi.org/10.1097/00001888-200312000-00002
152. Salam A, Rabeya, Y., Harlina HS, Mohammad N. Professionalism in medical education; A review. Eubios J Int Bioethics 2010; 20: 250-1.
153. Goldie J, Dowie A, Cotton P, Morrison J. Teaching Professionalism in the Early Years of Medical Curriculum: A Qualitative Study. Medical Education 2007; 41 (6): 610-7. http://dx.doi.org/10.1111/j.1365-2923.2007.02772.x (Accessed on 01/02/2013)
154. Cote L, Leclere H. How Clinical Teachers Perceive the Doctor-Patient Relationship and Themselves as Role Models. Acad Med 2000; 75 (11): 1117-24.
155. Wear D. On white coats and professional development: the formal and the hidden curricula. Ann Intern Med 1998; 129 (9): 734Â7. http://dx.doi.org/10.7326/0003-4819-129-9-199811010-00010 (Accessed on 05/04/2013)
156. Salam A, Siraj HH, Mohamad N, Das S, Yousuf R. Bedside Teaching in Undergraduate Medical Education: Issues, Strategies and New Models for Better Preparation of New Generation Doctors. Iranian J Med Sci 2011c; 36: 1-6.
157. Cruess RL, Cruess SR. Teaching medicine as a profession in the service of healing. Acad Med 1997; 72 (11): 941-52. http://dx.doi.org/10.1097/00001888-199711000-00009 (Accessed on 07/04/2013)
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.