Understanding the meaning of professionalism in healthcare students through the PROGRESS project

In this text the meaning of professionalism among nursing and healthcare degrees will be explored, how Finnish universities of applied sciences are centrally positioned to cultivate it deliberately into undergraduate education of nurses, and how the upcoming research project PROGRESS (2026-2029) could aid us at Arcada to understand professionalism in our nursing and healthcare students.

What is "professionalism" in healthcare?

According to Cao et al. (2023), professionalism is best understood through three core attributes: 1) it is multidimensional, 2) it changes over time and across a career, and 3) it is shaped by the culture and context in which care is delivered. Rather than a fixed checklist of behaviors, the same analysis defines nursing professionalism as the practice of caring for people according to principles of professional responsibility, caring, and altruism; values that are enacted differently depending on setting, patient population, and stage of a professionals’ development. (Cao et al., 2023)

For much of the twentieth century, professionalism was assumed to be absorbed implicitly, through clinical exposure and observation of seniors, rather than deliberately taught (Sadeq et al, 2025). Early accounts of professionalism in medical education emphasised traits such as expert knowledge, autonomy, and self-regulation. These were the classic sociological markers of a "profession". (Birden et al., 2014) Other noted components are ethical and value-based practice, accountability, respect for patient  or client autonomy and dignity, effective communication, collaboration within multiprofessional teams, commitment to lifelong learning, and reflective self-regulation of one's own competence and conduct (Cao et al., 2023; Khan et al., 2025). Professionalism, in other words, is the set of values, behaviors, and relational capacities that make competent clinical knowledge trustworthy in practice

A further challenge is that there is no standardised way to define, teach, or assess professionalism, which is precisely why explicit curricular attention matters (Cao et al., 2023; Jaramillo Villegas et al., 2025). Contemporary education in healthcare has therefore largely shifted from listing desirable traits toward understanding professionalism as an evolving professional identity: the process by which a student comes to think, feel, and act like a nurse, physiotherapist, or paramedic, rather than someone who has simply memorised a code of conduct (Cruess & Cruess, 2018). This “identity formation” lens is useful precisely because it explains why professionalism cannot be taught in a single lecture or assessed with a single checklist. Rather, it is built cumulatively, through repeated experience, feedback, and reflection, in much the same way that clinical reasoning is built through repeated exposure to cases. 

However, if left unmanaged, the informal "hidden curriculum”, i.e., values and behaviors which students absorb from role models, institutional culture, and unspoken norms, can just as easily undermine professionalism as build it. (Lawrence et al., 2019) An example of this comes from research on medical students, showing how negative role modelling and an institutional culture of “speeding up clinical encounters” can lead medical students to internalise dismissive or rushed behaviors without critically reflecting on them, producing a dissonance between the clinician they intended to become and the one the environment shaped them into (Barbosa et al., 2018).

The response from education internationally has thus been to move toward explicit teaching, structured reflection, and formal assessment of professional behavior, rather than leaving it to chance encounters on clinical placement. (Barbosa et al., 2018) A systematic review, by Khan et al (2025), on professionalism education interventions found that structured programs, including role modelling paired with guided reflection, longitudinal mentoring, professionalism-specific curricula, and portfolio-based assessment, produced measurable improvements in students' professional behaviors, although the review also noted that evidence for the long-term sustainability of these gains after graduation remains limited (Khan et al., 2025).

Understanding professionalism through the PROGRESS project

Literature on professionalism often tends to focus on medical or nursing professions overall. Longitudinal perspectives that capture change across time, including professional identity, ethical reflection, and the integration of theory and practice, remain rare, particularly so within the Finnish context. This creates a knowledge gap regarding how professionalism develops among different healthcare undergraduate students, specifically among nursing, midwifery, and paramedic nurses in Finland during their education. This gap is problematic, since clinical practice placements, supervision, and peer (or near-peer) interactions further shape students' professionalism in ways that cross-sectional data collection cannot capture. 

PROGRESS (Professionalism in Undergraduate Healthcare Students) is a three-year (2026–2029) research project that aims to map and compare the development of professionalism, i.e. professional identity, sense of belonging, role clarity, ethical reflection, and theory-practice integration, among healthcare students at Arcada. The project will include all academic years from the following degree programs at Arcada: Nursing, Emergency Care, Midwifery, and Public Health Nursing. The last three listed are double degrees with a nursing degree included. This design allows an exploration of professionalism and the impact of varying curriculum contents for four separate degree programs in healthcare. The project will further be conducted as an accelerated longitudinal mixed-methods study spanning a period of 1.5 years. This allows the developmental process to be mapped within a comparatively short timeframe. Currently, the PROGRESS project is unfunded, but plans are to apply for funding at a later stage, and to find relevant partnerships from work life.

Undergraduate professionalism education often emphasises standardised, top-down frameworks over relational and context-sensitive learning that students find meaningful. Furthermore, student perspectives remain underused in curriculum design despite directly shaping how future clinicians relate to patients (Khan et al., 2025). This risks diminishing the development of students’ professionalism. Structured opportunities for student feedback on placement culture, case-based ethics discussion led by near-peers and making space for students to reflect critically on what they observed, rather than simply absorbing institutional norms unreflectively, would help to avoid the trap of being experienced by students as abstract or disconnected from clinical reality. 

Furthermore, given that professional identity develops cumulatively over years, professionalism content is more effective when threaded through the entire degree; from first-year courses on values and communication, through mid-programme ethics and multicultural care content already embedded in the national competence framework, to reflective portfolios in the final placement year, rather than concentrated into a single early course that students later perceive as disconnected from "real" clinical work.

PROGRESS is expected to generate concrete recommendations for such curriculum development and for the students’ transition into working life, with a strengthening impact on education. In addition to practical implications, and research output, PROGRESS will also function as a hypothesis-generating, single-center pilot study, laying the potential groundwork for broader research at a larger scale.

Why professionalism matters for patients, professionals, and for systems

Medical and nursing professionalism have both been described as vital competencies because they directly shape the quality and safety of patient care (Khan et al., 2025; Kumari et al., 2024). Patients who experience their care team as ethical, communicative, and respectful are more likely to trust clinical recommendations, disclose relevant information, and adhere to treatment plans. All of these have clear downstream effects on health outcomes. Evaluating professionalism assessment across undergraduate and graduate medical education, Jaramillo Villegas et al (2025) similarly frames professionalism as a cornerstone of ethical healthcare, foundational to the implicit contract between the profession and the society it serves.

Professionalism education can also function partly as early identification and remediation of behaviors. Lapses in professionalism during training, i.e., dishonesty, poor accountability, disrespectful communication, are consistently associated with later disciplinary problems in clinical practice (Papadakis et al., 2005). Although the evidence base for which remediation approaches work remains thin (Brennan et al., 2020). Conversely, well-supported professional identity formation is linked to greater resilience against burnout, because students who have internalised a coherent sense of professional purpose are better equipped to navigate the ethically and emotionally demanding situations that characterise healthcare work (Cruess & Cruess, 2018).

Finally, professionalism matters for interprofessional collaboration, which is recognised as essential to safe and high-quality care (Bosch & Mansell, 2015). Effective teamwork and communication among physicians and nurses are critical to patient safety, and the professional behaviors that enable this, humility about one's own role boundaries, respect for other disciplines' expertise and willingness to escalate concerns, are learned, not innate (Yu et al., 2020). Studies among nursing and medical students have further found that simulation-based interprofessional education (IPE) significantly improves interprofessional collaborative competence and core nursing competence (Yu et al., 2020). Data from participants point to gains in communication, role clarity, and collaborative decision-making (Chang et al., 2025). Finnish UAS, including Arcada, has a strong simulation-based education, and increasingly deliver joint modules across nursing, physiotherapy, and paramedic degree programs (sometimes even in collaboration with medical educations). Designing these sessions around explicit professionalism and collaboration objectives could thus further strengthen professionalism for involved students.

Through exploring the development of professionalism explicitly, the PROGRESS project could thus indirectly help in enhancing our future healthcare personnel safety, and indirectly also patient safety, as well as further aiding our educators in further developing our future interprofessional collaborations.

Conclusion

Professionalism is not a peripheral "soft skill" bolted onto clinical training; it is one of the mechanisms that makes clinical competence trustworthy, safe, and sustainable across a nursing career. We need to move away from the assumption that professionalism is simply caught through clinical exposure, toward explicit, longitudinal, reflective, and well-assessed curricular attention, while acknowledging that the field still has real work to do to standardise definitions and assessment. However, significant knowledge gaps regarding how professionalism develops among healthcare students in Finland during their education is problematic, since clinical practice placements, supervision, and peer (or near-peer) interactions shape students' professionalism in ways that cross-sectional data collection cannot capture. We hope our three-year PROGRESS project will answer these questions.

An LLM (Claude Sonnet 5) was used to formulate the outline and edit the English throughout the text, as well as searching for certain research literature. No text was generated de novo, and no analysis was performed with AI. All sources were checked by the author. The author takes full responsibility for the content in the text.

Christoffer Ericsson, PhD, Degree Programme Director of Emergency Lead Master’s Programme

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