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Some interventions could help to reduce racism and rein in the use of unnecessary force in police work, but the evidence base is still evolving. Some interventions could help to reduce racism and rein in the use of unnecessary force in police work, but the evidence base is still evolving.

Abstract Disrespect and abuse during childbirth are violations of women’s human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers’ perspectives on the topic are limited. We examined providers’ perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women’s empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.

Academic integrity is the basis of an education system and must be taught as an ethical behavior during academic training. Students who reflect honesty and truthfulness during the academic years are more likely to follow this path, develop professional integrity, and thus become responsible and dependable professionals. Here, we determine the prevalence of academic lapses among medical students by a cross-sectional descriptive survey based on a self-assessment questionnaire. Students’ perception of 37 behaviors comprising five domains, plagiarism, indolence, cheating, disruptive behavior, and falsifying data, were explored. A high percentage of students (83%) indicated that all 37 behaviors constitute misconduct. Approximately 65% of students thought that their fellow students were involved in dishonest behaviors, and 34% answered that they were indulged in some form of misconduct. Content analysis identified some prevalent behaviors such as doing work for another student (82.5%), getting information from the students who already took the exam (82.5%), copying the answer from neighbors (79%), and marking attendance for absent friends (74.5%). Multiple regression analysis points out that future indulgence in a behavior is significantly (p≤0.5) correlated with understanding a behavior as wrong, perceiving that others do it and whether one has already indulged in it. This study can serve as a diagnostic tool to analyze the prevalence of misconduct and a foothold to develop the medical school system’s ethical guidelines.

Disrespectful and abusive practices at health facilities during childbirth discourage many women to seek care at facilities. This may lead to maternal morbidity and mortalities. Despite severe impacts, such practices remain hidden and are rarely reported in developing countries. The study was carried out to assess the prevalence and determinants of the disrespect and abuse (D & A) during child birth in rural Gujrat, Pakistan. A cross sectional household based study was conducted in tehsil Kharian of district Gujrat. Data was collected using an interview based questionnaire from the women who had a live birth within the previous two months (n = 360). The D & A scale was based on standard Maternal and Child Health Integrated Programme indicators. Multiple logistic regression was used to find out the determinants of reported D & A. Almost all women experienced D & A (99.7%) during childbirth according to objective assessment \"experienced D & A\". However, only 27.2% reported subjective experience of D & A \"reported D & A\". The main determinant of reported D & A was facility based childbirth (OR = 13.49; 10.10-100.16) and lower socio economic strata (OR = 2.89; 1.63-5.11). The risk of reporting D & A was twice in public health facilities as compared to private. Women who had reported D & A were more likely to opt for changing the place of childbirth for next time (OR = 4.37, 95% CI = 2.41-7.90). D & A during childbirth is highly prevalent and under-recognized in Pakistan. High prevalence at facilities and particularly at public facilities can be a reason for underutilization of this sector for childbirth. Maternal health policies in Pakistan need to be revised based on the charter of respectful maternity care.

Background Medical councils and associations frequently stress the importance of professionalism, yet unprofessional behaviors remain common. Such behaviors can compromise patient safety, especially in emergency departments, which face diverse conditions, heavy workloads, and demanding team interactions. Therefore, the present study aimed to investigate the incidence, pattern, and factors associated with unprofessional behavior experienced by emergency physicians in a developing country. Methods In this convergent parallel mixed-methods study, a nationwide online survey of emergency physicians and residents was conducted alongside in-depth interviews with residents and specialists from emergency medicine and other specialties between November 5 and December 5, 2024. Results Among 262 respondents (response rate: 40.3%), the majority were board-certified physicians (71.4%), were female (58.8%), and had 1–10 years of experience (81.7%). Approximately 90.8% of participants reported experiencing unprofessional behavior in the emergency departments during the past year. In particular, verbal aggression (85.9%) had the highest frequency, followed by online misconduct (33.6%) and physical aggression (7.6%). Younger physicians (< 35 years of age), those with 1–10 years of experience, and those who were dissatisfied with their income were more likely to encounter such behavior than others. Most incidents of unprofessional behavior occurred during consultations or patient handovers, with surgery and internal medicine specialists most commonly identified as perpetrators. Although most hospitals had reporting systems, less than half of the incidents were reported, mainly because of low perceived severity and lack of effective resolution. The reported consequences included reduced job satisfaction (67.2%), decreased professional confidence (46.2%), and negative effects on patient safety and outcomes (27.3%), including compromised clinical decision-making. The qualitative findings revealed that unprofessional behavior is often normalized in emergency departments, driven by high workload and inadequate communication. Concerns regarding clinical competency among emergency physicians and residents also emerged as a contributing factor. Conclusions Unprofessional behavior is widespread in Thai emergency medicine, which disproportionately affects younger physicians and undermines provider well-being and patient care. The results highlight not only individual challenges but also systemic gaps within the healthcare system. Thus, urgent, multilevel strategies are needed to address this issue and improve patient safety.

Unprofessional behaviour negatively affects staff and patient safety and wellbeing and organisational culture. It typically involves one perpetrator and target/s, as well as staff who may witness, report or respond to the incident, while positive behaviours may buffer experiences. Understanding nurses' experiences across these roles may support reducing unprofessional behaviour. This is the first 360° view of the roles that nurses play in unprofessional behaviour. To examine the frequency, type, severity and impact of unprofessional behaviours between nurses and between nurses and medical personnel; the experiences of reporting and responding unprofessional behaviours; and if nurses acknowledge or exhibit positive behaviours. Secondary analysis of a mixed-method study evaluating an all-staff professional accountability program ( ) implemented in eight Australian hospitals. Data included (i) cross-sectional surveys administered pre- and postimplementation (longitudinal investigation of negative behaviour surveys:  = 5178 baseline [  = 2248 nurses] and  = 3975 follow-up [  = 637 nurses] surveys), (ii) interviews with middle managers  = 30 (  = 12 nurses), (iii) 1310 reports of coworker unprofessional behaviours (  = 799 submitted by nurses,  = 538 about nurses) and 1194 reports of coworker positive behaviours (  = 787 by nurses,  = 595 about nurses), and (iv) messenger surveys  = 60 (  = 17 nurses). Analyses undertaken varied by data type: descriptive analysis for quantitative data and content or thematic analysis for qualitative data. Nurses exhibited unprofessional behaviours (perpetrators), most commonly towards other nurses (62%-90%) and were the targets of nurses (47%-70%) and medical colleagues (4%-34%). Nurses frequently observed unprofessional behaviour, with 51% witnessed it at least weekly. Many (46%) were not comfortable responding, with 44% believing they would not be considered seriously (reporters). Nurses indicated having the skills (83%) and training (87%) to respond to unprofessional incidents. However, they frequently used workarounds (interview theme) or reported insufficient time. Nurses frequently acknowledged others' positive behaviours (  = 1930, 67%), received positive feedback from nurses (1235 behaviours, 83%) and medical colleagues (94 behaviours, 6%). Nurses' roles in unprofessional behaviour may include perpetrator, target, observer, reporter, responder and buffer. Individual and organisational-wide approaches are required to confidently address unprofessional behaviours. Multifaceted culture change programs are needed.

Background Understanding 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? Methods Using 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. Results The 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. Conclusions The 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.