Worldwide interest in teaching medical professionalism has increased drastically over the past two decades and is recognized as an important core competency. It is also essential in pharmacy education. However, there is no single definition of medical professionalism owing to its multifaceted nature, leading to difficulty in understanding it. The foundational concept of professionalism are the social contract and accountability, which describe the relationship between the profession and the society which it serves. Profession must understand expectations from the society, which is trustworthy, assures competence, and devoted to the public good for the contract based on their mutual trust. In \"teaching,\" three basic educational actions (\"setting expectations,\" \"providing experiences,\" and \"evaluating outcomes\") are required. There are two learning goals of professionalism education: the minimum goal of not doing unprofessional acts and the aspirational goal of pursuing a higher level of interiorized professionalism which leads to the professional identity formation. The true professionals are \"reflective practitioners,\" who have the ability to manage ambiguous problems using their interiorized professionalism in complicated situations. Therefore, reflection is one of the central concepts of professionalism education. The Professionalism Mini-Evaluation Exercise (P-MEX), an observational tool to evaluate medical professionalism, has some favorable aspects; the Japanese version is available and is a guide to specific actions for professionalism through its items, although some cautions must be exercised when using it. Considering that teaching professionalism includes not only formal but informal and hidden curricula, all of the staff in the educational environments should consider professionalism education by understanding professionalism.

Directed reflection, a descriptive, analytical, and critical reasoning process, has been implemented in several professional fields as a method of developing expertise. In surgery, investigation of reflection has been limited. To date, we are unaware of any study that has sought to define or characterize the independent reflective practices of surgical trainees. In this small pilot study, we characterize the independent operative reflection activities among surgical residents at a single academic institution.
An unvalidated survey was developed through cognitive interviews and pilot testing to assess 5 aspects of operative reflection. An IRB approved electronic survey was developed and distributed to all general surgery residents at an academic institution. Responses were divided by post-graduate year into junior residents (JR; PGY 1-3) and senior residents (SR; PGY 4-5).
A response rate of 46% (23/50) was attained. All respondents self-identified as operative reflectors. Three primary methods of reflection were identified: mental, written, and oral. Mental reflection was the primary reflection method of 75% of our respondents as identified by step-by-step mental rehearsal, internal narration, and question series. Reflection was practiced everyday by 42% of respondents. Topics of reflection focused on weaknesses (50%), self-improvement (35%) and judgment (15%). Several respondents (57%) indicated that reflection-based learning tools would be useful. No statistically significant changes in the method or frequency were established between junior and senior residents (p = 0.378, p = 0.464, respectively). Variation in mental reflection activities among JR and SR groups were found (p = 0.029, p = 0.00004, respectively).
The enduring role of reflection in experiential learning has been established in many professional fields but remains under-utilized in surgical education. Our study suggests surgical residents reflect independently of curriculum in individual and categorizable ways. Further investigation is required to adequately characterize reflective habits of the surgical resident and evaluate its impact on competency.

BACKGROUND: In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers\' understanding of how students become socially responsive. The concept of \'critical consciousness\' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context.
METHODS: A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis.
RESULTS: Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies.
CONCLUSIONS: Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice.
CONCLUSIONS: Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.

This study aimed to chronicle and understand the emergency online teaching experience of five faculty members in a liberal arts college located in Tokyo, Japan during the COVID-19 pandemic of 2020, adopting the autoethnographic method. It explored the nature and dimensions of problems the faculty members faced, resources used to make sense of problems encountered, and actions they took to solve the problems as reflective practitioners in emergency online teaching. It also examined differences between faculty members over time. Analysis of seven weeks of autobiographic reflective journals during a 10-week academic term revealed that the faculty members encountered a range of problems during the classes, especially student-related and technology-related issues. When encountering problems, faculty members utilized references such as their past experience in face-to-face classroom teaching. Faculty members with more online teaching experience were more adaptable and flexible in mobilizing other references to solve problems. Overall, all members worked as reflective learners and practitioners who continued to reflect on the problems they faced and find solutions. These findings suggest that engaging in reflection-in-action and reflection-on-action can be effective ways for faculty members to develop their competencies to solve problems in emergency online teaching situations when responding to unprecedented challenges and issues is continuously needed.

Objective. To assess the impact of participation in a formal white coat ceremony on Doctor of Pharmacy (PharmD) students\' professionalization by analyzing students\' reflective writing. Methods. First-year PharmD students participated in the college\'s white coat ceremony following orientation. During the Foundations of Pharmacy course in the first semester, students were instructed to reflect on and write about the impact the white coat ceremony had on them as a graded assignment. A grading rubric was developed to standardize assessment of the reflections and to differentiate critical reflection (which cites future behavioral change) from other forms of reflection that are less impactful, such as non-critical reflection, general understanding, and non-reflection. Thematic analysis was conducted and prevalent themes were identified. Each reflection was then reviewed to identify up to three themes. Results. Of the 225 students in the incoming class of 2020, 218 submitted valid reflection assignments. Of these, 92% met critical reflection criteria. Four percent offered \"negative connotation,\" while 75% described an eye-opening experience or realization. Of 483 thematic classifications, six student professionalization themes were identified, as follows: personal achievement (26%), professionalism (21%), welcome to pharmacy (18%), patient care (16.8%), life-long learning (12.8%), and code of ethics (5.2%). Conclusion. For the majority of PharmD students, the white coat ceremony held during first-year orientation had a positive impact on their professionalization. All pharmacy schools should conduct a white coat ceremony that includes recitation of the Pledge of Professionalism as an impactful first step toward student professionalization.

OBJECTIVE: To describe, critically appraise and synthesise research regarding nurses\' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives.
METHODS: Mixed studies review.
METHODS: MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching.
METHODS: Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically.
RESULTS: Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care.
CONCLUSIONS: Registered Nurses have aligned their end-of-life care with practice with the profession\'s expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.

Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week\'s responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of \"reflective\" responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective.