Document Type : Original Article

Authors

1 Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran

2 Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Introduction: The concept of professional ethics of academic educational leaders is an abstract concept for which several
highly context-dependent definitions have been provided in the literature. The analysis of this concept is critical to reaching a shared understanding, developing behavioral standards, and designing evaluation measures at universities of medical sciences. This study aims to provide a comprehensive definition of professional ethics among educational leaders of universities of medical sciences.
Methods: To explain the concept of professionalism among academic educational leaders, Walker and Avant eight-stage
concept analysis method was adopted. After an extensive review of resources, 37 articles were included and the antecedents, attributes, and consequences of the concept were extracted.
Results: An examination of the resources and concept analysis revealed that professionalism in academic educational leaders has three main attributes of care ethics, justice-oriented ethics, and ethics of criticism, and its formation depends on personal characteristics, professional capabilities, and having a systemic view.
Conclusion: The identification of components and professional characteristics of professionalism among academic educational leaders provides a shared understanding of professionalism and is a basic step towards designing measures to evaluate this concept.

Keywords

Introduction

Today, leadership is a widely discussed aspect of higher education systems worldwide. Many problems in higher education in general, and in developing countries in particular, result from academic and organizational leadership. The leader’s efficiency, dynamism, insights, and personal and professional intelligence largely determine the success of institutions ( 1 ). Since universities are complex organizations in which the leader is challenged on different fronts, leadership is increasingly regarded as a major problem in this setting. The leader should deal with a diverse set of people, including academic faculty, administrative, technical, and support staff, and students ( 2 ).

The foundation of leadership is the knowledge of management based on attention and respect for ethical values. Professional ethics is the most important variable in organizational success, although people do not have a unique view of success and its definitions. Professional ethics means a set of rules that people should voluntarily and conscientiously adhere to in doing professional work, without any external requirement or legal punishment ( 3 ).

The principles of professional ethics are of a high value, and adherence to these principles plays a determining role in adhering to social norms. A weakness in the system of ethics reduces relationships and increases damage to the organization ( 4 ). The more managers and employees turn towards professional ethics in organizations, the more success the organization will have in achieving its predicted goals ( 5 ).

Adherence to professional ethics in the organization is essential so that the organization will not create a conflict in society, and ensure its long-term goals by making reasonable and wise decisions ( 6 ).

An examination of the status of ethical standards in the educational system can help policy-makers, managers, and educational planners to adopt suitable measures to reduce the distance between the status quo and the optimal situation, and promote the status of such standards ( 7 ). Moreover, the ethical behaviour of educational managers as leaders and decision-makers will have a positive effect on the existence and destiny of schools and universities, and with such ethics, the success of educational trends will be guaranteed ( 8 ).

Despite the importance, until quite recently, professionalism evaluation has been mostly implicit rather than explicit similar to many domains of knowledge and skills, and there is no agreement as to what belongs to the definition of professionalism or what it is. Therefore, experts disagree about the indicator with which professionalism should be evaluated ( 9 ). Due to the significance of this topic, researchers’ interest in this domain, and the evaluation of different sources showing the lack of a suitable and comprehensive definition for the professionalism of academic educational leaders, the present study analysed the concept of professionalism among these leaders to provide a basis for the growth of this competency.

Methods

This review study adopted Walker and Avant’s (2019) eight-stage concept analysis approach to examine the dimensions of professionalism among educational leaders as a key concept analysis in academic leadership in medical education. The 8-step concept analysis procedure of Walker and Avant (2019) was used as an organizational framework to show how concepts are defined in the current literature. Walker and Avant’s describes the following eight steps for completing a concept analysis. 1) Select a concept; 2) determine the purpose or objectives of the analysis; 3) identify uses for the concepts that can be discovered; 4) Determine defining attributes; 5) Identify model cases; 6) Identify borderline, related, contrary, invented and illegitimate cases; 7) Identify antecedents and consequences; 8) Define empirical references. Walker and Avant suggested identifying as many uses for the concept as possible. Ignoring the physical aspects of a concept can deprive the reader of valuable information about the concept ( 10 ).

After selecting the concept of professionalism in academic educational leaders, the references were searched in credible databases. English databases, including PubMed, Google Scholar, Scopus, ProQuest, and ERIC were searched. The selected keywords used in the search strategies, after examination in MeSH, were “professionalism”, “academic leadership”, “educational leadership”, and “concept analysis”, using Boolean operators of OR, AND, NOT.

These databases were searched without time limitation for the concept of professionalism in academic leaders in the titles and abstracts. Two investigators (HH and BM) independently screened the titles and abstracts of the included records and independently assessed them for eligibility using the following inclusion criteria: 1) The target population was academic; 2) English full-text, peer-reviewed journal articles, and original articles; 3) described the development of tools for professionalizing academic leaders; 4) Evaluated professionalism as a broad concept or competency facet.

Two reviewers independently and critically appraised the data, and then exchanged the information. First, we reviewed the titles of all articles and excluded those that contradicted the purpose of the study. In the next steps, the abstracts and then the full text of the articles were inspected to identify and exclude the studies that met the exclusion criteria and had a poor relationship with the research goals.

Subsequently, the studies selected by the two reviewers were evaluated based on the STORBE checklist for descriptive studies in terms of bias risk. After the final selection of the studies, the information was extracted and summarized by using a table designed in Excel. To organize the study, titles, and abstracts, and to identify duplicates, EndNote X8 was used. Finally, the results were systematically reported (Figure 1). The preliminary result of the search included 3840 articles. After removing irrelevant articles, articles shared across the databases, those having a poor relationship with the goals of the study, and poor-quality studies, 37 articles were included (Figure 1).

Figure 1. Stages of entering the article to this systematized review based on the PRISMA checklist.

Ethical consideration

This research was approved by the Research Ethics Committee of Iran University of Medical Sciences (Code of Ethics: IR.IUMS.FMD. REC.1399.018), and the principles of ethics in research presented in the Helsinki Declaration were followed. The article is part of the PhD thesis entitled “Development and Validation of a professionalism Questionnaire for academic leaders: sequential exploratory mixed-methods design” by Ms. Hengameh Habibi that was granted by Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences.

Results

Identify the Uses of the Concept

Over the past 25 years, the process of professionalism has been discussed as an established topic in the domain of clinical medicine and medical education. Determining the principles, operationalization, and evaluation of professionalism have been a major concern of medical conferences and top journals, and those active in the domain of medical education, including students, faculties, doctors, and researchers ( 11 ). Still, this topic is currently facing many ambiguities, disagreements and much confusion ( 12 - 14 ). Thus, attention to the significance of the topic and the dire need for effective academic educational leaders with professional ethics in universities of medical sciences and more focus on training educational leaders in healthcare organizations are required. The examination of resources suggested the absence of a suitable concept of professionalism for educational leaders of universities of medical sciences. Therefore, we aimed to analyze the concept of professionalism among these leaders.

The goal of this analysis was to examine the multiple dimensions of the concept of professionalism in academic educational leaders, define its attributes and uses, and finally propose a conceptual definition of professionalism in these leaders.

In any society, different professional groups follow a specific value system in addition to general ethical principles that are accepted by that profession, known as professional ethics ( 11 - 15 ). Researchers ( 16 ) have highlighted adherence to ethics in all the affairs of the organization and its effects on the organization’s efficiency and effectiveness.

The first step towards the realization of ethics in organizations is the identification of two ethical levels: Professional ethics, which means the ethical responsibility in organizations, and occupational ethics, which focuses on people's ethical duties in organizations ( 17 , 18 ).

Professional ethics is the major component of applied ethics that deals with ethical issues in the profession, explains and analyzes the ethical responsibilities and duties of the employees and organizations in businesses, and monitors ethics at the workplace ( 19 , 20 ). According to Morrison, professionalism is a multi-dimensional concept and a value-ridden word encompassing social, institutional, historical, and contextual expectations ( 21 ).

Professionalism, in a more limited sense, leads to the production of some specific attributes, which is the outcome of a gradual deformation of which the person is unaware. The final result of this process and change is visible only from the perspective of an external viewer. Professional transformation is mostly affected by the environment and the primary mentality of the human element, which is the focus of attention in that environment ( 22 ).

Over the years, much discussion has been driven towards the centrality and importance of academic leadership for the success of higher educational institutions, and many articles and references have tried to examine and discuss the nature of this concept. Some texts use the term “academic leadership” to describe a set of responsibilities or performances used by people appointed to official positions ( 23 ). More importantly, within universities, these people have scientific positions and are deputies, deans, or heads of departments ( 24 , 25 ). In some other sources, this term is used to describe any person with a scientific appointment. In some references, all academicians are academic leaders because it is assumed that they are at the front line of their discipline and are active in defining the future directions and strategies in their academic programs ( 26 - 28 ).

Academic leaders serve as important anchors; they direct at the time of change, are in charge of realizing educational goals, and should meet a high standard of professionalism in all aspects of behavior and action in order to play the role of a professional educational leader ( 24 ). Therefore, it is essential that the concept of professionalism of academic educational leaders be explained.

Attributes

Walker and Avant (2019) define an attribute as a set of repeated features describing a concept ( 10 ). This attribute has been repeated in a concept over and over, helping researchers differentiate it from similar concepts. Any concept contains more than one defining attribute; still, one should determine which attribute is more suitable for describing the concept. This definition includes all the variables on which researchers focus to determine the consequences and verify the concepts ( 10 ).

With the content analysis of relevant articles, the defining attributes of the concept of professionalism of academic educational leaders are presented in Table 1.

Primary codes Sub-categories Main category
● Having a spirit of appreciation for the progress of the organization and employees. Care ethics Professional ethics
● Staying calm in special and critical situations.
● Caring for/not hurting the employees.
● Having a spirit of cooperation.
● Having communication skills.
● Compassion
● Kindness towards subordinates/employees.
● Confidentiality and keeping the secrets of the system and employees.
● Having the power to direct.
● Doing good deeds.
● Having a sense of empathy.
● Being in control of one’s behaviour/self-control.
● Generosity towards employees.
● Enthusiasm for the system and the employees.
● Equal respect
● Equal behaviourFaith and adherence to moral principles.
● Commitment to values
● Pride in and respect for the system and employees.
● Creating hope in followers and employees.
● Having a spirit of humility.
● Integrity/honesty towards the system and employees.
● Strengthening lifelong learning.
● Having a spirit of moral courage.
● Having a spirit of teamwork.
● Creating a spirit of heroism in employees.
● Full attention to details. Justice-oriented ethics
● Being a role model for others.
● Having sufficient authority.
● Having freedom.
● Maximum benefit for the organization.
● Attention to consequences of actions.
● Stability and flexibility in decision-making.
● Information-based decision-making.
● Having a spirit of democracy.
● Having excellence.
● Having equity.
● Constructive use of data.
● Having a legal commitment to the university.
● Supporting people’s rights.
● Transparency and clarity of speech.
● Telling the truth.
● Not making personal exploitation or gains.
● Defence and support for the university’s ideals. Ethics of criticism
● Having full awareness and knowledge.
● Having courage.
● Ability to empower the employees.
● Having a risk-taking spirit.
● Being committed to the promotion of the university.
Table 1.Defining attributes of the concept of professionalism among academic educational leaders

Model Case

A model case consisting all attributes of a concept would be a real example ( 10 ).

Dr. Akbari, with 19 years of experience, is the deputy of Education at A university of medical sciences who made every effort to change the educational and class programs during the COVID-19 pandemic. In the initial step, he invited all faculty members to hold virtual classes, and enabled distance working on a shift basis for the department personnel. He demanded the colleagues who attended the workplace in person to adhere to health protocols. In all the in-person sessions, he adhered to the protocols. He checked the on-line classes continuously, and resolved the related structural problems. He also put continuing education regarding COVID-19 and virtual education on the agenda.

This case shows an ideal case of professionalism in an academic leadership and includes defining attributes of professionalism of an academic educational leader.

Borderline Case

This is when a case includes most or some attributes of the leadership. ( 10 )

Mr. Abdi is the deputy of education at B University of medical sciences. He tries to provide the best educational conditions for students in COVID-19 pandemic. He established virtual education and emphasized e-learning but did not care about teachers' criticism of e-learning infrastructure problems and only encouraged them to have more teamwork.

Contrary Case

Walker and Avant (2019) explain that a contrary case is an example without defining attributes ( 10 ).

The contrary case can express something that is not regarded as the main concept. Therefore, the following case cannot demonstrate the professionalism of academic educational leaders because it lacks the defining attributes.

Mr. Ahmadi is the deputy of education at C University of medical sciences. He has an autocratic leadership style and, during the COVID-19 pandemic, has continued leadership by placing commanding unity on the agenda. Despite the critical condition, he commands that the classes be held in person, and does not agree to the students’ request for time off. He does not believe in virtual education and providing the infrastructure, and encourages the students to prepare themselves to deal with the current condition.

Antecedents

Walker and Avant (2019) describe antecedents as events or incidents that must happen before a concept can occur ( 10 ). Primary antecedents that lead to the professionalism of academic educational leaders are given in Table 2.

Primary codes Sub-categories Main category
● Having sufficient and comprehensive information. Personal competencies
● Having sufficient communication skills.
● Familiarity with the competencies of academic leaders.
● Familiarity with the problem-solving approach.
● Having scientific knowledge.
● Effective membership in the board of directors. Professional capabilities domain of competence and capability
● Effective management.
● Effective performance monitoring and assessment.
● Having managerial competence.
● Commitment to organizational culture. Having organizational commitment
● Commitment to academic values.
● Commitment to the perspective.
Table 2.Antecedents of professionalism in academic education leaders

Consequences

Consequences or outcomes are formed when events or incidents occur as a result of this concept ( 10 ). The consequences of professionalism among academic educational leaders are given in Table 3.

Primary codes Sub-categories Main category
● Commitment to advancement of science. Professional commitments of the academic leader Excellence of the university
● Commitment to high-quality teaching.
● Commitment to promoting the educational rank.
● Commitment to promoting the research rank.
● Commitment to academic values.
● Responsibility for healthcare.
● Commitment to promoting the quality of patient care.
● Accepting the mistakes.
● Developing a better relationship with a wider community. Academic leader’s foresight
● International competition.
● Promoting the rank of the university.
● Attracting external capital.
● Positive effect on the efficiency and effectiveness of the university.
Table 3.Consequences of professionalism among academic education leaders

Empirical referents

The final stage of concept analysis is the identification of empirical referents for the defining attributes. Empirical referents show how the concept is measured and to what extent the definition can help the measurement and validation of the concept ( 10 ). Despite various studies on professionalism in medical education in the past three decades, there is no globally accepted measure for professionalism in academic educational leaders ( 29 ). However, various instruments have been developed and used to measure medical professionalism and have been used in many empirical studies ( 30 - 32 ). Classification of instruments are given in Table 4 ( 33 ).

No. Type of tool use
1 Self-administered rating
2 Simulation
3 Direct observation
4 Multi Source Feedback
5 Peer assessment
6 Patients’ opinion
7 Role model evaluation
8 Professionalism environment
Table 4.Classification of instruments

Discussion

The promotion of ethics in organizations is one of the most important responsibilities of the managers in educational organizations. As research and educational centers, universities should be ethical in their interaction with the students, professors, employees, and the external environment ( 34 , 35 ). Moreover, our understanding of professionalism varies according to time and cultural context, suggesting that professionalism is a complex and multidimensional structure ( 36 ).

Based on the concept analysis, the proposed definition for an educational leader committed to professional ethics is as follows: Academic educational leaders who follow care ethics, justice-oriented ethics, and the ethics of criticism as the guiding principles of their affairs.

Educational Leadership without ethics and integrity can be harmful both for the university stakeholders and society. In the current study, ethic of care refers to empathy, self-control, communication skills, lifelong learning, having a spirit of teamwork and caring for the employees. Ciulla believes that part of being a leader is caring and being responsible for others. But caring is not only about oneself, it is also attention, concern and active participation with others ( 37 ).

In another study, ethics of care was defined as the leadership work necessary for developing caring and respectful relationships with staff, students, and community members to create a positive and enjoyable atmosphere that fosters a sense of belonging and meaning ( 38 ).

justice-oriented ethics is an important feature of ethical leadership. In this concept analysis, the meaning of justice-oriented leadership is fairness, equity, sufficient authority, having a spirit of democracy and telling the truth.

Diem and Carpenter advanced the basic idea that social justice educators must assume politically active figures, such leaders are true problem solvers in the communities they serve ( 39 ).

The concept of ethics of criticism is the last characteristic in current study. Ethics of criticism refers to awareness and knowledge, having a risk-taking spirit and being committed to the promotion of the university.

Shariatmadari’s study showed that justice-oriented leadership had six dimensions of causal conditions (with two components of organizational factors and attitudinal factors), central phenomenon of justice-oriented leadership (with four components of behavioural patterns and moral characteristics, support through two-way communication, strengthening moral behaviour and decision making), strategies and actions (with two components of achievement of reward through performance and achievement of goals through reward), intervening conditions (with three components of management differences, staff differences and management changes, underlying conditions (with two components of factors encouraging fair behaviour and factors threatening fair behaviour) and consequences (with three components of school-related outcomes, staff-related outcomes and managers-related outcomes) ( 40 ).

Conclusions

The proposed definition for an educational leader committed to professional ethics is as follows:

The educational leader puts caring ethics, justice-oriented ethics and the ethics of criticism at the top of his actions. In the theme of caring ethics, he is a person who is in control of his behavior, who has a sense of empathy, respect, kindness, and a spirit of gratitude towards his subordinates, and tries to take care and not harm the employees. In times of crisis, he keeps his calmness and tries to guide others. He adheres to ethical principles, norms and values. He plans team work and considers life-long learning as one of the main goals of his educational group. In the category of justice-oriented ethics, the educational leader has the spirit of democracy, fairness, transparency and openness in speech and does not hesitate to tell the truth in any situation. He supports people's rights and he is committed to the university. In the field of critical ethics, the educational leader is a brave, risk-taking, informed person who has a creative and critical spirit and is fluent in the cultural language of the university.

Acknowledgement

The current study is part of the PhD thesis entitled "Development and Validation of a professionalism Questionnaire for academic leaders: sequential exploratory mixed-methods design" that granted by CERMS of the Iran University of Medical Sciences. The authors appreciate collaboration of all the study participants whose participation promoted this research.

Author Contribution

Hengameh Habibi contributed to data collection, data analysis, and writing and critically revising the paper. Shoaleh Bigdeli involved in planning, data collection, and data analysis and critically revising the paper. Zohreh Sohrabi contributed to data analysis and writing the paper. Abbas Ebadi contributed to data collection and data analysis. All authors collaborated in the study, and all read and approved the final manuscript.

Conflict of Interest

None declared.

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