Health professions education and unprofessional behaviour in the global south: a scoping review of conceptions, theoretical frameworks, and prevalence.

backgroundUnderstanding how unprofessionalism is interpreted and enacted in low- and middle-income countries is essential for developing health professionals that are contextually and socially grounded. The scoping review explores and maps existing scientific evidence on unprofessional behaviour in health professions education from a Global South perspective. The review was informed by the research question: How is unprofessional behaviour defined, conceptualised, and framed theoretically in health professions education within the Global South?

methodsUsing a scoping review, we retrieved 382 articles, of which 14 articles were published between 2004 and 2024. The articles were retrieved across PubMed/MEDLINE, Scopus, Web of Science, EBSCOhost (Academic Search Complete, Health Source, and PsycINFO) databases, and supplemented by Google Scholar.

resultsThe studies emerged from 10 countries, with the majority conducted in the United Arab Emirates (21.4%), followed by Saudi Arabia and Thailand with 14.3% each, and other countries each contributing 7.1% of the total studies. The highest number of studies was published in 2017, 2020, and 2023 (14.3% each). Most study designs were cross-sectional (71.5%), while qualitative studies accounted for 21.4%, and mixed methods were 7.1%. The study populations predominantly consisted of medical students (64.4%), followed by residents (14.3%), and smaller groups including multi-disciplinary students (Medicine, Pharmacy, Nursing), clinicians and medical students, and clinical faculty members and medical students with 7.1% each. The studies were conducted across academic and clinical settings (50.0%), with others focusing solely on clinical environments (28.6%), preclinical settings (14.3%), and a clinical and surgical training environment (7.1%). Five key themes emerged: Academic Dishonesty and Integrity Violations, Bullying and Harassment, Clinical and Ethical Misconduct, Disrespect and Power Abuse, and Neglect of Professional Responsibilities.

conclusionsThe study findings draw attention to the need for theoretical engagement and institutional reforms that reflect the realities of educational and clinical training environments in low- and middle-income countries.