The majority of participants responded with the “strongly agree” and “agree” categories within the three domains of the professionalism perception competency survey, indicating that the participants perceived all items of professionalism to be important, regardless of their professional levels, place of practice, age and gender. In our study, the ranges of participants’ responses to the three domains of professionalism survey i.e., “professional attitude and behavior: PAB”, “ethics and jurisprudence: EJ” and “communication and interpersonal skills: CIS” were 82–99%, 75–98% and 86–98% respectively. These were higher than what was reported in a previous investigation of perception of professionalism among 386 dental graduates of eight public- and private-sector dental colleges in Pakistan [29], where the corresponding figures to those in our study were 51–99%, 60–97% and 61–91%. The differences between our findings and those reported in the aforementioned study may be attributed to the differences in teaching and application of the professionalism subject in the BDS curricula. Further support to this explanation can be inferred from previous investigations which showed inadequate infection control practices among senior faculty members in Karachi, Pakistan [35] as compared to their prior knowledge of such measures, and the high prevalence of musculoskeletal disorders among general dental practitioners in Pakistan which is most probably due to poor teaching and application of proper ergonomics during their BDS programme [36]. Furthermore, many dental curricula in developing country may not prepare their students to work well in disadvantaged populations with special oral health needs [37]. It is part of our dental curriculum to make our students fully aware of the factors that impact on oral health needs of the community including socio-economic inequities. Furthermore, we have a mobile dental clinic with regular students’ allocation to serve the rural, elderly, and disadvantaged populations.
In our study, participants did not consider maintaining Continuing Professional Development (CPD) as important as the other items of the PAB domain. This is due to the need to invest a lot of time and money in activities which may not be considered as important especially those that were deemed non-compulsory by regulatory bodies [29, 38].
The item which was considered by our participants as the least important among all domains of professionalism was “have knowledge of the judicial, legislative and administrative processes and policy that impact all aspects of dentistry”. A similar finding was also reported in previous studies [29, 39], which may be attributed to the lack of a formally structured and taught course addressing ethics and legal issues in many dental curricula [40].
Looking closely at the responses to the items within each domain, in the “PAB” domain, items that were considered most important by participants were “displaying appropriate caring behaviour towards patients and showing willingness to help” and “displaying professional behaviour towards all members of the dental team”, whereas the item which was deemed the least important was “seeking continuing professional development (CPD) on an annual basis, demonstrated through portfolio/CPD Logbook”. In the “EJ” domain, participants considered “providing humane and compassionate care to all patients” and “practicing with personal and professional integrity, honesty and trustworthiness” as the most important items, whereas the item “have knowledge of the judicial, legislative and administrative processes and policy that impact all aspects of dentistry” was considered as the least important one. In the “CIS” domain the items “establishing a patient-dentist relationship that allows the effective delivery of dental treatment including, when appropriate a relationship with a parent or carer” and “identifying patient expectations, desires and attitudes (needs and demands) when considering treatment planning and during treatment” were deemed by participants as the most important ones, whereas, the item “communicating with other doctors and health professionals, verbally and in writing including being able to receive and give constructive criticism” was considered as the least important item. The above findings agree with Chaudhry et al. study [29] where a similar pattern of importance was also reported by their participants.
The Correlation between the different domains of professionalism showed significant relationships between the total domain scores for the PAB and EJ, the PAB and CIS, and the EJ and CIS (p < 0.001). This indicates that all domains of professionalism are inter-related and if participants have a good knowledge of one domain, they are very likely to be good at the remaining domains of professionalism. Furthermore, this provides an evidence to the appropriate use of the questionnaire as the three domains contributed in a similar way to the overall assessment of professionalism.
In order to investigate the relationship between knowledge and practice of professionalism, a correlation was tested between the mean of the three professional domains (PAB, EJ, and CIS) and their relevant response scores (applications 1 & 2). It was found that the mean score percentage for the PAB domain was significantly higher than the responses reported in question 3 and 4 which were meant to test the application of the knowledge in the PAB domain. This means that participants’ knowledge of the PAB domain was significantly better than their application of such knowledge when tested in clinical practice. Similarly, participants’ knowledge of the EJ and CIS domains were significantly better than their application of such knowledge. These differences between the knowledge of the three domains of professionalism and their application in clinical practice suggest that teaching professionalism should start with a cognitive base, reinforced through case-based scenarios, and internalized throughout the clinical practice phase of the curriculum (experiential learning) [41]. This necessitates a strong support of the teaching of professionalism throughout the educational program.