PROfessionalism in Partnership for Education Research (PROPER) study: a novel online initiative approach to professionalism education

Introduction
Medical education must ensure medical students graduate with the appropriate values, attitudes, and behaviours that allow them to work collaboratively with patients and families from a range of diverse cultural backgrounds. The PROfessionalism in Partnership for Education Research (PROPER) study aimed to assess the impact of an online educational intervention on medical professionalism for undergraduate medical students in two jurisdictions, focusing on behaviours and cultural sensitivity.

Methods
The PROPER study employed a quasi-experimental, mixed-methods design with intervention and control groups formed by participants self-selection. underpinned by the Theory of Planned Behaviour (TPB), the intervention comprised four online workshops, using scenario analyses and reflective practices, addressing confidentiality, raising concerns, self-care, and cultural awareness. Quantitative survey data were collected at three time points: pre-workshop, immediate post workshop (short-term) and three months follow-up and qualitative data were obtained through focus group discussions (FGDs). Quantitative analyses included paired and independent t-tests, while qualitative data were analysed thematically.

Results
Forty-one participants (intervention = 31, control = 10) were included. The most notable change was observed in perceived behaviour control for self-care, which significantly improved from pre- to post-workshop (P < 0.05). For other constructs, improvements were observed but did not reach statistical significance. Other TPB items showed similar directions of change, where decreases or no improvements were observed. FGDs (n = 5, 24 participants) analysis identified four key themes across the combined workshops: perspective enhancement, enabling self, dialogic reflection, and strengthening axiology. These themes highlighted evidence in increased self-awareness, confidence, and the early development of professional values among participants.

Discussion
Despite limited statistical evidence, qualitative insights suggest PROPER intervention may be a promising model for online undergraduate professionalism education, combining a structured programme and reflection to enhance collaboration and cultural competence. Challenges such hierarchical norms, structural barriers and participants’ relative lack of clinical experience were perceived to limit long-term behaviour change. More evidence is needed in this area, focusing on incorporating experiential learning and addressing contextual barriers at a larger sample size to sustain professionalism behaviour.