From duty to dialogue: the evolution of professional trust across two generations in Mauritius
Résumé
Background Medical professionalism is a core component of health professions education (HPE), yet prevailing frameworks have largely been developed from provider perspectives and within Western contexts. The perspectives of patients and communities, particularly in African and multicultural settings, remain underrepresented. In addition, little is known about how generational differences shape expectations of professional conduct in healthcare. Methods This qualitative narrative inquiry investigated perceptions of medical professionalism among 32 participants in Mauritius, including 16 from Generation Z and 16 from Generation Y. Data were collected through individual narrative interviews guided by six flexible prompts: (1) an instance when a healthcare worker exceeded expectations; (2) a moment of uncertainty or discomfort in a healthcare environment; (3) a time they observed or experienced unprofessional behaviour; (4) what stood out most to them; (5) their interpretation of what it means to be a professional doctor; and (6) how their personal values influenced their expectations of doctors. The prompts served as flexible narrative guides rather than a rigid interview schedule. Participants were encouraged to develop their narratives freely and in their own sequence, with follow-up probes used where appropriate to clarify meanings, elicit further detail, and deepen their accounts. This approach provided consistency in the broad areas explored across participants while remaining aligned with narrative inquiry principles by privileging participants' experiential accounts and meaning-making. Interviews were conducted in English, French, or Mauritian Creole and transcribed verbatim. Ethical approval was secured from the National Ethics Committee of the Republic of Mauritius (Protocol MHC/CT/NETH/2025/A V2). Results Nine themes were identified. Six themes: Humanised Care, Communication and Information Sharing, Respect and Dignity, Ethical Integrity and Trustworthiness, Accountability and Consequences, and Clinical Competence were strongly represented across both generations, forming a shared relational moral core consistent with Ubuntu-informed understandings of professionalism. Three themes showed significant generational differences. References to consent, autonomy, cultural sensitivity, and partnership-based communication were prominent in most Generation Z interviews. In contrast, Generation Y participants emphasised professional duty, vocation, moral responsibility, and stewardship more frequently. The most distinctive finding was the prominence of Duty, Vocation, and Moral Obligation among Generation Y participants (9/16) and their complete absence from Generation Z narratives (0/16). These differences suggest contrasting mechanisms through which professional trust is established and maintained. Discussion These differences seem to reflect varying social environments rather than a decline in professional values. Generation Y grew up within more hierarchical healthcare relationships, where trust was primarily established through professional authority and moral obligation. In contrast, Generation Z has been raised in a digitally connected, rights-conscious environment that emphasises the active construction of trust through dialogue, transparency, and participation. Thus, medical professionalism in Mauritius can be understood as a fundamentally relational moral practice rooted in dignity, empathy, integrity, accountability, and competence, which serve as core values that resonate across generations, even as the preferred methods for fostering professional trust vary by cohort. Rather than signalling a shift from relationality to autonomy, these findings indicate a transition between different forms of relational professionalism. This study offers community-based insights to inform the development of culturally responsive and generationally sensitive professionalism curricula, particularly in African and other multicultural healthcare contexts.
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