Professionalism in small group learning between face-to-face and virtual settings: a mixed-methods study.

Objectives: To explore whether and how preclinical medical students changed perceptions and behaviors related to professionalism in small group learning activities from face-to-face to virtual during the pandemic. Methods: The study used a mixed-methods sequential research design. We first retrospectively examined quantitative data from 101 medical students who completed mandatory peer evaluation surveys assessing professional behaviors of small group members in two courses (one face-to-face, the other online). Differences between student perceptions in two settings were compared using the Wilcoxon signed-rank test. Findings from the quantitative stage were probed further using focus groups at the qualitative stage. Six focus groups (n = 27) were conducted using purposeful sampling. Interviews were transcribed and inductive thematic coding was used to identify emerging themes. Results: We found a significant decrease in perceptions of punctuality and attendance in the virtual setting compared to face-to-face learning (Z=-6.211, p<.001), despite lower expectations of their peers in online learning. Five major themes emerged from the qualitative data: punctuality/participation, camera usage, dress code/conversational style, multitasking, and engagement/accountability. Participants showed sensitivity when conceptualizing professional conduct, indicating the dynamic process of professional identity formation at the early stage of their career. Conclusions: Results show that students' perceptions of professionalism become contextualized, significantly influenced by the background of the virtual learning environment. Intentional communication about professionalism within specific sociocultural and educational contexts is vital for individual professional identity formation. These findings support of the importance of considering context when educational programs develop curricula and establish expectations related to professionalism.