Putting the Professionalism Charter Into Practice in GME


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Putting the Professionalism Charter Into Practice in GME

  1. 1. Putting the Professionalism Charter Into Practice in GME Harry R. Kimball, MD, MACP IHI/ACGME Conference on Professionalism New Orleans, Louisiana December 1, 2003
  2. 2. ABIM Foundation ACP Foundation European Federation of Internal Medicine
  3. 3. ABIM Foundation Troy Brennan, Project Chair Jordan Cohen Harry Kimball Neil Smelser Linda Blank, Project Staff European Federation of Internal Medicine Gunilla Brenning Chris Davidson Philippe Jaeger Alberto Malliani Hein Muller Daniel Sereni Eugene Sutorius ACP Foundation Robert Copeland Risa Lavizzo-Mourey Walter McDonald Special Consultants Sylvia and Richard Cruess Jaime Merino Project Members
  4. 5. Questions <ul><li>Why do we need a charter on medical professionalism today? </li></ul><ul><li>Can the charter make a difference to practicing physicians, residents and medical students, and to patients? </li></ul><ul><li>How will its impact and effectiveness be measured? </li></ul>
  5. 6. THE PHYSICIAN CHARTER Annals of Internal Medicine, The Lancet, February 2002 <ul><li>Three Fundamental Principles </li></ul><ul><li>Primacy of Patient Welfare </li></ul><ul><li>Patient Autonomy </li></ul><ul><li>Social Justice </li></ul>
  6. 7. THE PHYSICIAN CHARTER <ul><li>A Set of Responsibilities and Commitments to: </li></ul><ul><li>Professional Competence </li></ul><ul><li>Honesty with Patients </li></ul><ul><li>Patient Confidentiality </li></ul><ul><li>Maintaining Appropriate Relations With Patients </li></ul><ul><li>Improving Quality Care </li></ul><ul><li>Improving Access to Care </li></ul><ul><li>Distribution of Finite Resources </li></ul><ul><li>Scientific Knowledge </li></ul><ul><li>Maintaining Trust By Managing Conflicts of Interest </li></ul><ul><li>Professional Responsibilities </li></ul>
  7. 8. <ul><li>Lifelong professional development </li></ul><ul><li>Maintenance of certification </li></ul>Commitment to Professional Competence 1
  8. 9. Examinations <ul><li>Impaired physicians (self-regulation) </li></ul><ul><li>Patient’s right to refuse treatment (patient autonomy) </li></ul><ul><li>Abuse of power (inappropriate physician-patient relationships) </li></ul><ul><li>Pregnancy/HIV (confidentiality) </li></ul>
  9. 11. <ul><li>Work collaboratively to: </li></ul><ul><ul><li>– Reduce medical error </li></ul></ul><ul><ul><li>– Increase patient safety </li></ul></ul><ul><ul><li>– Minimize overuse </li></ul></ul><ul><ul><li>– Optimize outcomes of care </li></ul></ul><ul><li>Help develop and implement better measures of quality health care </li></ul>Commitment to Improving Quality of Care 5
  10. 12. Quality Improvement Practicum for IM Residents and Faculty <ul><ul><li>Collaboration: ABIM Foundation, ABIM, and Alliance for Academic Internal Medicine </li></ul></ul><ul><ul><li>Selected Residency Programs </li></ul></ul><ul><ul><li>Preventive Cardiology Practice Improvement Module (PIM) </li></ul></ul><ul><ul><li>Tests applicability as educational experience in quality assessment and improvement </li></ul></ul>
  11. 13. Maintaining Trust by Managing Conflicts of Interest <ul><li>Recognize the existence of many opportunities to pursue private gain </li></ul><ul><li>Disclose all conflicts of interest involving professional activities </li></ul><ul><li>Importance of reflective practice </li></ul>9
  12. 14. Commitment to Professional Responsibilities <ul><li>Participate in the processes of self-regulation </li></ul><ul><li>Assist in establishing educational and standard-setting activities </li></ul><ul><li>Accept external scrutiny of professional performance </li></ul>10
  13. 15. ABIM Strategies for Evaluating Professionalism in GME <ul><li>Examinations </li></ul><ul><li>Program Director Ratings </li></ul><ul><li>Structured Evaluations (Mini-CEX) </li></ul><ul><li>Peer and Patient Ratings </li></ul><ul><li>Professionalism Portfolios </li></ul>
  14. 16. Program Director Ratings Annual evaluations of professionalism along with other competencies, 9 point scale <ul><li>superior </li></ul><ul><li>satisfactory </li></ul><ul><li>marginal </li></ul><ul><li>unsatisfactory </li></ul>2
  15. 17. Professionalism Ratings (1990-1998) Unsatisfactory Ratings: N= 758 74% men Age: 31.6 47% USMG 53% IMG Outcomes: 381 Left internal medicine 377 Completed training 269 Attempted certification 193 Passed
  16. 18. Structured Evaluations in Professionalism: New Generation X Mini-CEX 3
  17. 19. Quality Improvement Plan ABIM Scores Report 10 Peers 25 Patients Self-Assessment Select raters; Distribute surveys; Use interactive voice response system to complete Patient and Peer Assessment 4
  18. 20. Professionalism Portfolios <ul><li>show evidence of competence </li></ul><ul><li>promote self-reflection and self-awareness </li></ul><ul><li>stimulate self-directed learning </li></ul><ul><li>foster a healthy professional lifestyle that leads to achieving long-term career goals </li></ul>A promising strategy to: 5
  19. 21. The Competent Physician <ul><li>David Leach and the ACGME provide the following definition: </li></ul><ul><li>&quot;The competent physician habitually incorporates three elements into daily work: evidence-based medicine, patient-centered care, and reflective practice.&quot; </li></ul><ul><li>The Charter on Medical Professionalism reaffirms these elements and provides a contemporary framework for both action and realization. </li></ul>
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