Professionalism in medicine (Dr. Mohamed Al-Rukban)
Professionalism in Medicine ByDr. Mohammed O. Al-Rukban Associate Professor Family Medicine Consultant
Do You Still Remember A Role Model Who Influenced Your Training? If Yes? Mention Some of Their Qualities and Attributes.
Professionalism• What is professionalism?• How can we Implement it in the Curriculum?• How can we Teach it?• How can we Assess it?
What does professionalism means to you? • Take a few minutes and write down your thoughts … as a definition or description.
What is Professionalism?• It is not easy to define a profession, but it is likely to have all or Some of the following characteristics: – It is a vocation or calling that implies service to others – It has a distinctive knowledge base which is kept up to date – It determines its own standards and sets its own examinations – It has a special relationship with those whom it serves e.g. patients, students…. – It has particular ethical principles
• Professionalism is a term which embodies numerous qualities of physicians as public servants.• It has been described by The American Board of Internal Medicine (ABIM) as: “Constituting those attitudes and behaviors that serve to maintain others interest above physician Self-interest”
الطبيب المسلم مهن ٌ بطبعه ي “ ويؤثرون على أنفسهم ولو كان بهم خصاصة“ “ إن ا يحب من العامل إذا عمل أن يتقن“ “ إذا ذبحتم فأحسنوا الذبحة.........” “ ل يؤمن أحدكم حتى يحب لخيه ما يحب لنفسه..”
Project Professionalism (ABIM, 2001)Developed the Physician Charter and identified six key elements of professionalism:1- Altruism (giving priority to patient interests rather than self-interests);2- Accountability (being answerable to patients, society and profession);3- Excellence (conscientious effort to perform beyond ordinary expectation, and commitment to life-long learning);
Project Professionalism (ABIM, 2001)4- Duty (free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care);5- Honor and integrity (being fair, truthful, straightforward, and keeping to ones work);6- Respect for other (respect for patients and families, colleagues, other healthcare professionals and students and trainees).
The concept of professionalism includes the following values:Honesty CommunicationTrust AccountabilityService Life-long learningCommitment
Defining Professionalism What specific behaviors are unprofessional inclassroom and clinical settings?
Examples of Unprofessional Behaviors Classroom Setting-Students/Trainee• Arriving for class late and/or leaving early• Being unprepared for group sessions• Not completing assigned tasks• Disrupting class sessions• Failing to attend scheduled class sessions• Cheating on an exam
Examples of Unprofessional Behaviors Classroom Setting-Students/Trainees• Using Mobile Phone during class• Chatting during class• Focusing on the test vs. learning• Prejudging content in advance• Intolerance of the opinions of others
Examples of Unprofessional Behaviors Classroom Setting-Faculty• Plagiarism• Judgmental attitude or favoritism• Coming late• Sloppy handouts and syllabi• Abusive behavior• Using Mobile Phone during class
Examples of Unprofessional Behaviors: Clinical Setting-Students• Dressing inappropriately• Avoiding work and/or responsibilities• Exhibiting little empathy for patients• Demonstrating lack of sensitivity to patients’ cultural backgrounds• Not protecting patient confidentiality
Examples of Unprofessional Behaviors: Clinical Setting: Faculty• Showing favoritism• Failing to attend scheduled sessions• Using inappropriate language or behavior• Asking learners to perform personal tasks, for example, picking up laundry
Common Examples• Marketing for a new drug?• Conflicts between government vs private commitments.
Signs and Symptoms The work of Project Professionalism (ABIM, 2001) describes unprofessional behaviour in terms of seven broad categories of signs and symptoms.1- Abuse of power (abuse while interacting with patients and colleagues; bias and sexual harassment; and breach of confidentiality);2- Arrogance (offensive display of superiority and self-importance);3- Greed (when money becomes the driving force);
Signs and Symptoms4- Misrepresentation (lying, which is consciously failing to tell the truth; and fraud, which is conscious misrepresentation of material fact with the intent to mislead);5- Impairment (any disability that may prevent the physician from discharging his/her duties);6- Lack of conscientiousness (failure to fulfill responsibilities);7- Conflicts in interests (self-promotion/ advertising or unethical collaboration with industry; acceptance of gifts; and misuse of services – overcharging, inappropriate treatment or prolonging contact with patients).
Professionalism and Curriculum Design Performance Of Task
KnowledgeDecision making skills and clinicalreasoning and judgment Patient managementBasic, Social andclinical sciences Patient investigation Performance Of task Clinical skills Practical proceduresPersonal Development Health promotion and& Lifelong Learning Disease preventionRole of the doctor within the health service and community
Professionalism• Role of the doctor within • Personal Development the health service – Lifelong Learner – Understanding of the – Self awareness health care system – Self confidence – Understanding of clinical – Self regulation responsibilities • Self care – Appreciation of doctor as • Self control researcher • Personal time – Appreciation of doctor as management mentor or teacher – Motivation – Appreciation of doctor as • Achievement drive manager including quality • Commitment control • initiative – Team working – Career choice
Professionalism in the Curriculum There is strong support for professionalism to be considered as: A learning outcome (ACGME, 2007; Harden et al., 1999; CanMeds 2000), A skill set (Emanuel, 2004) or A competence (Leach, 2004; Hester and Kovach, 2004; Fryer-Edwards & Baernstein, 2004). Many medical schools have their integrated curriculum content about professionalism within their curriculum, added courses on professionalism in the first two years, or have introduced behaviour into the clinical clerkships (Whitcomb, 2002).
Curriculum content relating to professionalism The key attributes of a professional: ethics, decision making/moral reasoning, humanism, multiculturalism, empathy values, truth telling, care for the vulnerable, trust, attitudes and communication, confidentiality of patient data, contact with patients, emotional intelligence, mental health, and self- assessment (using reflective practice). systematic review, Veloski et al. (2005) These should be integrated into the component courses of the curriculum rather than taught as a stand alone course.
How Students Learn Professional Values Bring some to medical school with them. Learn some through the formal curriculum. Learn some from role models.
When Are Values Taught?1.4 1.41.2 1.2 1 10.8 0.80.6 0.60.4 0.40.2 0.2 0 0 AM PM Eve Long Post Short Off Shift Type Call
How can We Teach Professionalism?• Role Modeling• Bed Side Teaching• Simulated Patients• Small Group Discussions
Assessment of Professionalism Structured, standardized rating scales are the most effective measure. The Outcome Project (ACGME, 2007) and Project Professionalism (ABIM, 2001) Rating scales have been used in two contexts: to assess performance in the workplace, through direct observation (Cohen, 2001); and to assess how the students respond to case vignettes (ACGME, 2007). The PMEX (Professionalism Mini Evaluation Exercise) of the ABIM (Norchi et al., 2003) and EPRO-GP (van de Camp et al., 2005) are examples of rating scales for assessing professionalism in the workplace. For assessing professionalism using case vignettes, both ACGME (ACGME, 2007) and ABIM (ABIM, 2001) have compiled compendia of case vignettes.
Assessment of Professionalism Rating scales have been used to assess professionalism in a variety of settings. ACGME, for example, uses rating scales in: self- assessment; direct observation by faculty; ethics OSCE stations; peer-assessment (Hafferty, 2002); and 360 degree assessment (Kirk, 2007). All the above rating scales have demonstrated validity and feasibility. (Holmboe et al., 2003; van de Camp et al., 2005) Reliability, however, in many of these examples is not yet available.
How can We Assess Professionalism?• Peer Evaluation-Does• Patient Surveys-Does• Staff evaluations-Does• Professionalism Portfolio (self evaluation)- Does• 360 degree evaluation-Does
Take Home Messages• Professionalism should be part of the formal curriculum• Professionalism must be taught and assessed• Professionalism must be relevant to the society it serves
Final Word “There is a tendency to underemphasize the personalcharacteristics… , because they are harder to measure, and to overemphasize the more easily measured indices of academic achievement” Cohen (2002)