title: Perception of medical professionalism among the surgical community in the University of Nairobi: a mixed method study.
abstract: BACKGROUND
  Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya.
  
  
  METHODS
  A sequential mixed methods study was conducted among clinicians, students and patients at Kenyatta National Hospital on the surgical wards from March 1(st)-December 31(st), 2014. The first phase of the study involved focus group discussions (FGDs) of between 10-12 persons and individual in-depth interviews of senior faculty and patients. Grounded theory method was used for collecting perceptions of participants on professionalism. These views were then coded using Atlas 5.2, allowing the development of a questionnaire that provided the survey tool for the second phase of the study. For the questionnaire, response options utilized a 4-point Likert scale with a range from "strongly agree" to "strongly disagree". Factor analysis was used to analyse the responses to the survey. Internal reliability was determined by Cronbach's α.
  
  
  RESULTS
  Sixteen FGDs and 18 in-depth interviews were held with 204 clinicians, students and patients. A further 188 participants completed the questionnaire. Respect was the most frequently mentioned or picked component of professionalism during the interview and survey respectively, with 74.5 % of participants reporting "strongly agree". Factor analysis showed that 3 factors accounted for the majority of the variance in the items analysed; respect in practice, excellence in service and concern for the patient. The Cronbach's α for this analysis was 0.927.
  
  
  CONCLUSIONS
  The study cohort predominantly conceptualizes professionalism as relating to respect between colleagues and toward patients. Respect, being a cultural norm, should form part of the core curriculum of professionalism in order to be relevant for the Kenyan context.
authors.affiliation: Department of Surgery, College of Health Sciences, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya. danielojuka@gmail.com.
authors.forename: Daniel Kinyuru
authors.initials: DK
authors.lastname: Ojuka
authors.affiliation: School of Public Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Olenja
authors.affiliation: Department of Surgery, College of Health Sciences, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
authors.forename: Nimrod J
authors.initials: NJ
authors.lastname: Mwango'mbe
authors.affiliation: Department of Medical Education, Yonsei University, Seoul, South Korea.
authors.forename: Eunbae B
authors.initials: EB
authors.lastname: Yang
authors.affiliation: Department of Surgery, School of Medicine, Kenyatta University, Nairobi, Kenya.
authors.forename: Jana B
authors.initials: JB
authors.lastname: Macleod
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D013502:General Surgery / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D000068616:Professionalism; D013337:Students, Medical / Q000523:psychology