Lecture given by Dr. Mohammed Al-Rukban for 4th year medical students in KFMC-FOM on Monday March 05, 2012

1. Professionalism
in
Medicine
By
Dr. Mohammed O. Al-Rukban
Associate Professor
Family Medicine Consultant

2. Do You Still Remember A Role Model
Who Influenced Your Training?
If Yes? Mention Some of Their
Qualities and Attributes.

3. Professionalism
• What is professionalism?
• How can we Implement it in the
Curriculum?
• How can we Teach it?
• How can we Assess it?

4. What does professionalism means to
you?
• Take a few minutes and write down your
thoughts … as a definition or description.

5. 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

6. • 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”

7. ‫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..”‬

8. '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);

9. '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 one's
work);
6- Respect for other (respect for patients and
families, colleagues, other healthcare
professionals and students and trainees).

10. The concept of professionalism
includes the following values:
Honesty  Communication
Trust  Accountability
Service  Life-long learning
Commitment

11. Defining Professionalism
What specific behaviors are
unprofessional in
classroom and clinical settings?

12. 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

13. 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

14. 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

15. 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

16. 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

17. Common Examples
• Marketing for a new drug?
• Conflicts between government vs private
commitments.

18. 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);

19. Signs and Symptoms
4- 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).

20. How professionalism can be
implemented?

21. Professionalism and Curriculum Design
Performance
Of Task

22. Knowledge
Decision making skills and clinical
reasoning and judgment Patient management
Basic, Social and
clinical sciences Patient investigation
Performance
Of task Clinical skills
Practical procedures
Personal Development
Health promotion and
& Lifelong Learning
Disease prevention
Role of the doctor within the health service and community

23. 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

24. How professionalism can be
taught?

25. 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).

26. 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.

27. How Students Learn
Professional Values
 Bring some to medical school with
them.
 Learn some through the formal
curriculum.
 Learn some from role models.

28. When Are Values Taught?
1.4 1.4
1.2 1.2
1 1
0.8 0.8
0.6 0.6
0.4 0.4
0.2 0.2
0 0
AM PM Eve Long Post Short Off
Shift Type Call

29. How can We Teach
Professionalism?
• Role Modeling
• Bed Side Teaching
• Simulated Patients
• Small Group Discussions

30. Do that.. &
Don’t do that

31. Follow Me

32. How can professionalism be
Assessed?

33. Performance
or hands on
Does assessment
Professionalism
Portfolios
Shows how
Written,
Knows how Oral or
Computer
Knows based
assessment
Miller’s Triangle

34. Use Suitable Assessment
Tools
• Multiple choice questions-Knows??
• Faculty evaluations-Knows, knows
how, shows how??
• Clinical vignettes & OSCE & OSPE-
Knows, knows how??
• Standardized patients-Knows how,
shows how??

35. 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.

36. 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.

37. How can We Assess
Professionalism?
• Peer Evaluation-Does
• Patient Surveys-Does
• Staff evaluations-Does
• Professionalism Portfolio (self evaluation)-
Does
• 360 degree evaluation-Does

38. 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

39. Final Word
“There is a tendency to
underemphasize the personal
characteristics… , because they are
harder to measure, and to
overemphasize the more easily
measured indices of academic
achievement”
Cohen (2002)