Document Type : Original Article


Department of Medical, Student Research Committed, Shiraz University of Medical Sciences, Shiraz, Iran


BACKGROUND: Considering the importance of virtual professionalism and professional ethics
in medical sciences, and the necessity to pay attention to this issue and its impact on medical
professionalism, this study aimed to build a professional culture questionnaire in a virtual environment
for students of medical sciences in Iran.
MATERIALS AND METHODS: This is an exploratory, sequential, mixed‑methods research which
was conducted in three sections. In the first section, the concept of e‑professionalism in medical
sciences was analyzed using the hybrid concept analysis in the theoretical work, field work, and final
analysis stages in order to extract information related to the concept. In the second section, an item
of the questionnaire was designed based on the concept, reviewed texts, and related questionnaires,
in the third section, psychometric properties of a questionnaires were evaluated.
RESULTS: Totally, 39 items were included in the initial pool, which reduced to 33 items in the final
questionnaire after reviewing the psychometric properties. Factor analyses led to extraction of five
factors including appraisal of e‑professionalism compliance with the laws and regulations governing
cyberspace, individual professionalism, knowledge management, respect for professionalism in
interpersonal and group rules, and complying with ethics in the use of cyberspace. The internal
consistency of questionnaire was also confirmed by Cronbach’s alpha coefficient of 0.78, also all
factor correlations absed stability were significant (P < 0.05).
CONCLUSION: An exploratory sequential study in this study led to the extraction of five factors
and development of a 33‑item questionnaire in e‑professionalism. As results and analysis of the
psychometric properties and validation of each item, this questionnaire is valid and reliable for the
assessment of levels of e‑professionalism in medical sciences in Iran.


  1. de Marcos Ortega L, Barchino Plata R, Jiménez Rodríguez ML,
    Hilera González JR, Martínez Herráiz JJ, Gutiérrez de Mesa JA,
    et al. Using m‑learning on nursing courses to improve learning.
    Comput Inform Nurs 2011;29:311‑7.
    2. McLeodRP, MaysMZ. Back to the future: Personal digital assistants
    in nursing education. Nurs Clin North Am 2008;43:583‑92, vii.
    3. Chipps J, Pimmer C, Brysiewicz P, Walters F, Linxen S, Ndebele T,
    et al. Using mobile phones and social media to facilitate education
    and support for rural‑based midwives in South Africa. Curationis
    4. Clay CA. Exploring the use of mobile technologies for the
    acquisition of clinical skills. Nurse Educ Today 2011;31:582‑6.
    5. Young P, Moore E, Griffiths G, Raine R, Stewart R, Cownie M,
    et al. Help is just a text away: The use of short message service
    texting to provide an additional means of support for health
    care students during practice placements. Nurse Educ Today
    6. Westmoreland GR, Counsell SR, Tu W, Wu J, Litzelman DK.
    Web‑based training in geriatrics for medical residents:
    A randomized controlled trial using standardized patients to
    assess outcomes. J Am Geriatr Soc 2010;58:1163‑9.
    7. Welke TM, LeBlanc VR, Savoldelli GL, Joo HS, Chandra DB,
    Crabtree NA, et al. Personalized oral debriefing versus
    standardized multimedia instruction after patient crisis
    simulation. Anesth Analg 2009;109:183‑9.
    8. Roh KH, Park HA. A meta‑analysis on the effectiveness of
    computer‑based education in nursing. Healthc Inform Res
    9. Feng J, Chang Y, Chang H, Erdley WS, Lin C, Chang Y. Systematic
    review of effectiveness of situated e‑learning on medical
    and nursing education. Worldviews Evidence‑Based Nurs
    10. Zhou Y, Yang Y, Liu L, Zeng Z. Effectiveness of mobile learning
    in medical education: A systematic review. Nan Fang Yi Ke Da
    Xue Xue Bao 2018;38:1395‑400.
    11. Kolko BE, Rose EJ, Johnson EJ. Communication as
    information‑seeking: The case for mobile social software for
    developing regions. In: Proceedings of the 16th International
    Conference on World Wide Web. ACM DI Digital Library 2007.
    p. 863‑72.
    12. Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C.
    Evidence of effectiveness of health care professionals using
    handheld computers: A scoping review of systematic reviews.
    J Med Internet Res 2013;15:e212.
    13. Abim F, Acp‑Asim F. Medical professionalism in the new
    millennium: A physician charter. Obstet Gynecol 2002;100:170.
    14. de Marcos Ortega L, Barchino Plata R, Jiménez Rodríguez ML,
    Hilera González JR, Martínez Herráiz JJ, Gutiérrez de Mesa JA,
    et al. Using m‑learning on nursing courses to improve learning.
    Comput Inform Nurs 2011;29:311‑7.
    15. Omurtag K, Turek P. Incorporating social media into practice:
    A blueprint for reproductive health providers. Clin Obstet
    Gynecol 2013;56:463‑70.
    16. Savel RH, Munro CL. Scalpel, stethoscope, iPad: The future is
    now in the intensive care unit. Am J Crit Care 2011;20:275‑7.
    17. Greysen SR, Kind T, Chretien KC. Online professionalism and
    the mirror of social media. J Gen Intern Med 2010;25:1227‑9.
    18. Hamm MP, Chisholm A, Shulhan J, Milne A, Scott SD, Given LM,
    et al. Social media use among patients and caregivers: a scoping
    review. BMJ open. 2013;3.
    19. Hawn C. Take two aspirin and tweet me in the morning: How
    Twitter, Facebook, and other social media are reshaping health
    care. Health Aff (Millwood) 2009;28:361‑8.
    20. Freidson E. Professionalism, the third logic: On the practice of
    knowledge. Wiley: University of Chicago Press; 2001.
    21. Fenwick T. Social media and medical professionalism: Rethinking
    the debate and the way forward. Acad Med 2014;89:1331‑4.
    22. Gevertz D, Greenwood G. Crafting an effective social media policy
    for healthcare employees. Health Law 2009;22:28.
    23. van Tulder M, Furlan A, Bombardier C BL. Editorial Board of the
    Cochrane Collaboration Back Review Group. Updated method
    guidelines for systematic reviews in the Cochrane Collaboration
    Back Review Group. Spine (Phila Pa 1976) 2003;28:1290.
    24. Schwartz‑Barcott D. An expansion and elaboration of the hybrid
    model of concept development. Concept Dev Nurs Found Tech
    2nd ed. Philadelphia:Saunders 2000.p.129-59.
    25. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA,
    Schoene M, et al. 2015 updated method guideline for systematic
    reviews in the Cochrane Back and Neck Group. Spine (Phila Pa
    1976) 2015;40:1660‑73.
    26. Lawshe CH. A quantitative approach to content validity 1. Pers
    Psychol 1975;28:563‑75.
    27. Ayre C, Scally AJ. Critical values for Lawshe’s content validity
    ratio: Revisiting the original methods of calculation. Meas Eval
    Couns Dev 2014;47:79‑86.
    28. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator
    of content validity? Appraisal and recommendations. Res Nurs
    Health 2007;30:459‑67.
    29. Lawshe CH. A quantitative approach to content validity.
    Personnel Psych 1975;28:563‑75.
  2. 30. Rubio DM, Berg‑Weger M, Tebb SS, Lee ES, Rauch S. Objectifying
    content validity: Conducting a content validity study in social
    work research. Soc Work Res 2003;27:94‑104.
    31. Krishna H KK. Reliability estimation in generalized inverted
    exponential distribution with progressively type II censored
    sample. R J Stat Comput Simul 2013;83:1007‑19.
    32. De Boer MR, Moll AC, De Vet HC, Terwee CB, Völker‑Dieben HJ,
    van Rens GH. Psychometric properties of vision‑related quality
    of life questionnaires: A systematic review. Ophthalmic Physiol
    Opt 2004;24:257‑73.
    33. Ness GL, Sheehan AH, Snyder ME, Jordan J, Cunningham JE,
    Gettig JP. Graduating pharmacy students’ perspectives on
    e‑professionalism and social media. Am J Pharm Educ 2013;77:146.
    34. Cleary M, Ferguson C, Jackson D, Watson R. Editorial: Social
    media and the new e‑professionalism. Contemp Nurse
    35. Cain J. Social media in health care: The case for organizational
    policy and employee education. Am J Health Syst Pharm