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Assessment of Professionalism in Dental Education

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Presentation given by Sandra Zijlstra-Shaw at the Dental Education Journal Club, 12 November 2012.

Presentation given by Sandra Zijlstra-Shaw at the Dental Education Journal Club, 12 November 2012.

What is professionalism in medicine and dentistry, how do we assess it?

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Assessment of Professionalism in Dental Education Assessment of Professionalism in Dental Education Presentation Transcript

  • Assessment ofProfessionalismDental Education Journal Club University of Sheffield School of Clinical Dentistry S. Zijlstra-Shaw November 2012
  • Journal articles Integrating professionalismAssessing professionalism into the curriculum: within dental education: the need for a definition AMEE Guide No. 61S. Zijlstra-Shaw, P. G.Robinson and Helen O‟Sullivan, Walther van T.E. Roberts, Mook, Ray Fewtrell & Val WassEur J Dent Educ Medical Teacher 2012;16(1):e128-36 2012; 34: e64–e77
  • Assessment of Professionalism• The GDC puts professionalism at the heart of our agenda.• The scope of what the GDC requires of students goes beyond academic achievement, and incorporates the attitudes, values and behaviours needed for registration.• The education or training provider must ensure anyone involved in the supervision and training of students is adequately trained to carry out the role, both clinically and as appropriate in terms of assessment and reporting of student progressThe General Dental Council Preparing for practice Dental team learning outcomes for registration 2012
  • What is Professionalism? Professionalism is defined as the body of qualities or features characteristic of a profession O.E.D. 1993
  • Characteristics of a ProfessionThe essential attributes of a profession are having • A systematic body of knowledge • Professional authority and credibility • Regulation and control of members • A professional code of ethics • A culture of values, norms, and symbols. Ernest Greenwood 1957
  • Characteristics of a ProfessionHippocratic Oath
  • Cruess & Cruess 1997 “Physicians have a unique societal role as professionals who are dedicated to the health and caring of others. Their work requires the mastery of a complex body of knowledge and skills, as well as the art of medicine. As such, the Professional Role is guided by codes of ethics and a commitment to clinical competence, the embracing of appropriate attitudes and behaviors, integrity, altruism, personal well-being, and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a physician and society. Society, in return, grants physicians the privilege of profession-led regulation with the understanding that they are accountable to those served.”
  • Medical Professionalism“Professionalism is demonstrated through afoundation of clinical competence,communication skills, and ethical and legalunderstanding, upon which is built the aspirationto and wise application of the principles ofprofessionalism: excellence, humanism,accountability and altruism.” D T Stern 2006
  • What is Professionalism? “Professionalism is also a sociological phenomenon since professional status is granted by society. Professionals have, therefore, an obligation to meet the requirements of the society in which they practice”Irvine D. The performance of doctors. I: Professionalism and self-regulation in a changing world.BMJ 1997: 314 (7093):1540-1542
  • Royal College of Physicians 2005“Medical professionalism signifies a set of values,behaviours, and relationships that underpins thetrust the public has in doctors”Medicine is a vocation in which a doctor‟s knowledge, clinical skills, and judgement are put in the serviceof protecting and restoring human well-being. This purpose is realised through a partnership betweenpatient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.In their day-to-day practice, doctors are committed to: • Integrity • Compassion • Altruism • Continuous improvement • Excellence • Working in partnership with members of the wider healthcare team.These values, which underpin the science and practice of medicine, form the basis for a moral contractbetween the medical profession and society. Each party has a duty to work to strengthen the system ofhealthcare on which our collective human dignity depends.
  • Medical ProfessionalismBalance between many factorsInternal Connected to person / personality of professionalExternal Context, social or cultural environment Perceived wishes of patient Interpretation of evidence or scientific base Hilton and Slotnick 2005
  • Professionalism is more“commitment to one‟s work as a career so that one’s workbecomes part of one’s identity” Eliot Freidson1970
  • Professionalism• Personal qualities• Societal values
  • Professionalism and Dentists“Standards for dental professionals”• Putting patients‟ interests first and acting to protect them.• Respecting patients‟ dignity and choices.• Protecting the confidentiality of patients‟ information.• Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients.• Maintaining your professional knowledge and competence.• Being trustworthy General Dental Council Standards for Dental Professionals 2005
  • Professionalism and Dentists • A competence • Professional attitude and behaviour • Ethics and jurisprudenceCowpe et al 2010 Profile and competences for the graduating European dentist –Update 2009
  • Professionalism and Dentists Recognise the role and responsibility of being a registrant and demonstrate professionalism through their education, training and practice in accordance with GDC guidanceThe General Dental Council Preparing for practice Dental team learning outcomes for registration 2012
  • Student Fitness to Practice• GDC publication 2010
  • What is fitness to practise? Students must demonstrate during their education and training that they have the knowledge, skills and attitudes expected of a registered dentist or dental care professional.Student Fitness to Practice GDC April 2010
  • GDC•greater clarity is needed in discussing professionalism,ethics and fitness to practise Shaw 2009
  • Professionalism is MORE • “to be real professionalism has to be something that people – professionals – actually „do‟..”.Evans L, Professionalism, Professionality and the development of Education ProfessionalsBritish Journal of Educational Studies, 2008
  • Aspects of professionalism Altruism Working with others Autonomy Social responsibility Excellence Trustworthiness Compassion Self-awareness Accountability Self-motivation Moral Reasoning Reflection Honesty and integrity Respect Knowledge of ethical standardsZijlstra-Shaw S, Robinson PG, Roberts T: Assessing professionalism within dental education; the need for a definition. Eur J Dent Educ; 2012Feb;16(1):e128-36
  • What is Professionalism? Agree a definition of professionalism the first step is to define professionalism in dentistry and develop a validated operationalised construct
  • Assessment of Professionalism Literature on assessment of professionalism suggests that not only should the purpose of assessments be clearly defined, but that the evaluation of both the assessment tools and the assessment system should be individually tailored to ensure that it is appropriate.
  • Student Assessment• Assess progress and direct future learning• Summarise achievement• Indicate readiness to progress• Provide feedback• Motivate learning• Ensure safety and quality of care for patientsAfter Wood 2007
  • Aim of Assessment Students develop an understanding of professionalism and demonstrate professional behaviours in everyday practice
  • AMEE Guide• Agree on a definition for your own institution• Setting expectations: agreeing the framework• Can you teach professionalism? Models of learning• Building experience into the formal and informal curricula• Addressing unexpected consequences: the hidden curriculum• Assess the learning outcomes• Evaluating programme Integrating professionalism into the curriculum: AMEE Guide No. 61 Helen O‟Sullivan, Walther van Mook, Ray Fewtrell & Val Wass, Medical teacher 2012; 34: e64–e77
  • Assessment of Professionalism• Agree a definition of professionalism and base learning outcomes on this definition• Integrate professionalism across the whole curriculum (formal, informal and hidden)• Provide opportunities to assess professionalism in multiple contexts, by multiple assessors, longitudinally and triangulate the results• Provide clear statements of the purpose of each assessment• Ensure that the programme is evaluated and improvements made based on the evaluationsHawkins et al 2009, Hodges et al 2011, O‟Sullivan et al 2012
  • Assessment of Professionalism• Begin early as this helps identify the personal traits required to be professional• Multiple assessment methods are needed• Assessment should be carried out on multiple occasions• Assessment should be carried out by multiple assessors• Longitudinal assessment is required as the assessment of patterns of behaviour is crucial, furthermore students develop professionalism over time Consilium Abeundi 2002, Van Mook et al 2009, O‟Sullivan et al 2012
  • Assessment Levels Miller’s pyramidMiller GE The Assessment of Clinical Skills/Competence/Performance Academic Medicine 1990: 65(9 Suppl):S63–S67
  • Assessment Categories• Written assessment• Competency based assessment• Performance based assessment• Portfolios
  • Written assessment• Knows and Knows how levels• MCQ‟s, SSAQ‟s, Essays etc.• Knowledge of the judicial, legislative and administrative processes and ethical principles• Written journals to assess reflection
  • Competency based assessment• Shows how level• Standard patient encounters and Objective structured, clinical examinations (OSCE‟s)• Variable interpretation observable behaviour• May not reflect actual performance• Earlier stages of the curriculum• “Tick-box mentality”
  • Performance based assessment• Does level• Working environment – variable context• Direct observation• Self-assessment, peer assessment, staff assessment, 360o feedback• Variable interpretation observable behaviour• Reluctance to document unprofessional behaviour
  • Portfolios• All four levels• Provide evidence of competence and progression• May stimulate reflection• Integrate multiple components• Variation in type and content – prescriptive or discretional• Integration into the curriculum• Need tutor support (training issues)• Time consuming for students and staff
  • Challenges Assessing professionalismProfessionalism is ill-defined• Requires clarification Arnold 2002• no a priori evidence documenting individuals‟ beliefs about professionalism ..., an essential first step to developing a validated assessment instrument Jha et al., 2006
  • Challenges Assessing professionalismA complex construct• Intangible collections of abstract concepts and principles• Inferred from behaviour• Explained by educational or psychological theory2nd order competence• Expressed only via performance of other competences Downing 2003 Verkerk et al., 2007
  • Integrating professionalism into thecurriculum: AMEE Guide 61 There is a risk that competence-based curricula and a „can do‟ approach to assessment fail to encourage motivation to continue to improve. We cannot afford to stand still. Teaching, learning and assessment practice must be based on evidence and, despite the already significant literature, it is equally apparent that much more research is required;Integrating professionalism into the curriculum: AMEE Guide No. 61Helen O‟Sullivan, Walther van Mook, Ray Fewtrell & Val Wass Medical teacher 2012; 34: e64–e77
  • Assessing professionalism withindental education: the need for adefinition In order to enhance dental education via the assessment of students‟ professionalism, the first step is to define professionalism in dentistry and develop a validated operationalised construct. Then educational programmes can be developed which teach professionalism and students can be assessed on the domains within the construct.Assessing professionalism within dental education; the need for a definition.S Zijlstra-Shaw , PG Robinson, TE Roberts Eur J Dent Educ; 2012 Feb;16(1):e128-36
  • Professionalism Assessment Strategy • Clear goals • Defensible • Multiple contexts, assessors, assessment methods • Reward Excellence • Incorporate Reflection • Integrate across the curriculum • Role Modelling/hidden curriculum • Evaluation
  • ToDiscoverAndUnderstand.