A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine.

Objectives: An essential aspect of medical education is to facilitate the development and assessment of appropriate attitudes towards professionalism in medicine. This systematic review provides a summary of evidence for measures that have been used to assess these attitudes and their psychometric rigour. It also describes interventions that have been found to be effective in changing such attitudes.

Methods: MEDLINE, EMBASE, ERIC, PsychINFO, Sociological Abstracts and CINAHL were searched from the respective start date of each database to May 2006. Three key journals and reference lists of existing reviews were also searched. Articles that were published in English and reported primary empirical research measuring medical students' attitudes towards medical professionalism were included. The findings are integrated in narrative structured in such a way as to address the research questions.

Results: A total of 97 articles were included in the review. Most measures of attitudes assessed attitudes towards attributes of professionalism such as ethical issues, the patient-doctor relationship and cultural issues. Fourteen studies measured attitudes towards professionalism as a whole and 44 studies reported both the reliability and validity of measures. No interventions reported a change in attitudes over time.

Conclusions: There is little evidence of reported measures that are effective in assessing attitudes towards professionalism in medicine as a whole. Likewise, there is scant evidence of interventions that influence attitude change over a period of time. Future studies should take into account the need to measure more global attitudes rather than attitudes towards specific issues in professionalism and the need to track attitudes throughout the curriculum.