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What is Medical Professionalism? (What is Professionalism in Medicine?)

The document discusses medical professionalism, outlining essential principles such as autonomy, beneficence, non-maleficence, and justice, which guide ethical healthcare practices. It emphasizes the importance of patient welfare, integrity, and continuous improvement in medical practice while also detailing the Accreditation Council for Graduate Medical Education (ACGME) core competencies related to professionalism. Additionally, it highlights various behavioral signs of professionalism that contribute to maintaining the trust of patients and the public in healthcare providers.

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What is Medical Professionalism? Alvina Pauline D. Santiago, MD December 7, 2018
CHED: 10 Program Outcomes for Medicine 1. Clinical Competence 2. Communicate effectively 3. Lead and manage health care teams 4. Engage in research activities 5. Collaborate with interprofessional teams 6. Systems-based approach to healthcare 7. Continuing personal and professional development 8. Ethical, professional and legal standards 9. Nationalism, internationalism, dedication to service 10. Social accountability CHED Memorandum Order 18, Series of 2016. Policies, Standards and Guidelines for the Doctor of Medicine Program, https://ched.gov.ph/wp- content/uploads/2017/10/CMO-18-s.-2016.pdf. Accessed November 11, 2018.
•Health Care Ethics •Bioethics •Set of moral principles, beliefs, and values that guide us in making choices about medical care From Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html. Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/
• Evaluating merits and difficulties of medical procedures • To be ethical must meet all 4 principles: • Autonomy • Justice • Beneficience • Non-maleficence Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/ 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
Autonomy • Honor patient’s right to make own decision • Autonomy of thought, intention, action when making decisions • Free of coercion or coaxing • Fully informed consent • All risks and benefits declared • Likelihood of success 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
Beneficence • For patient’s own good • Procedure provided with intent of doing good for patient • Physician should • develop and maintain skills and knowledge • Update training • Consider patient’s individual circumstances • Strive for net benefit 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
Non-maleficence • Procedure does not harm • First do no harm 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 2. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
Justice • Be fair and treat like cases alike • Burden and benefit of new procedures distributed equally among all groups in society • Uphold existing laws • Fair to all players involved 1. Fair distribution of scarce resources 2. Competing needs 3. Rights and obligations 4. Potential Conflicts with Existing laws 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
Accreditation Council for Graduate Medical Education (ACGME) Core Competencies • Practice-based learning and improvement • Patient care and procedural skills • Systems-based practice • Medical Knowledge • Interpersonal and communication skills • Professionalism NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). January 12, 2017 https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December 2, 2018.
ACGME: Professionalism Principles • Treat all people with respect, compassion, and dignity • Patient needs will supersede a resident’s self interest • Accept and understand accountability to patient, colleagues and society • Treating diverse patient population with sensitivity and respect. NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/
ACGME: Professionalism Sub-competencies • Demonstrating professional conduct and accountability • Demonstrating humanism and cultural proficiency • Maintaining Emotional, physical and mental health • Pursuing continual personal and emotional growth NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/
Medical Professionalism ACGME Core Competencies 1999 Medical Professionalism Project 1999 Professionalism Charter 2002 Adoption by Major Physician Organizations Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical Center)vol. 20,1 (2007): 13-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018
Professionalism Charter • Primacy of patient welfare • Altruism, trust, patient interest • “market forces, societal pressures and administrative exigencies” must NOT compromise this principle • Patient autonomy • Incorporates honesty • Educate and empower patients to make appropriate medical decisions • Social justice • Physician’s societal contract and distributive justice • Consider available resources and needs of all patients while taking care of individual patient American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium- physician-charter. Accessed December 4, 2018.
Professionalism Charter A Set of Professional Responsibilities /Commitment • Professional competence • Honesty with patients • Patient Confidentiality • Maintaining appropriate relations with patients [and colleagues] • Improving quality of care • Improving access to care • Just distribution of finite resources • Scientific knowledge • Maintaining trust by managing conflicts of interest American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium- physician-charter. Accessed December 4, 2018.
Medical Professionalism https://slideplayer.com/slide/4898007/16/images/2/ETHICAL+AND+LEGAL+UNDERSTANDING.jpg
Medical Professionalism A set of values, behaviors, relationships that underpins the trust the public has in its physicians. • Integrity • Compassion • Altruism • Continuous improvement • Excellence • Partnership with healthcare team • Honor 1. Engel et al, Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi: https//doi.org/10.1136/bmj.b4716. 2. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573. 3. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings- Fund-May-2008_0.pdf. 4. Working Party of the Royal College of Physicians Clinical Med 2005 Nov-Dec; 5 (6 Suppl 1): S5-40.
• Belief system • Profess to each other & public • Shared competency standards • Ethical values • Expectations ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
ABMS Medical Professionalism 1. Ethical value system 2. Knowledge and technical skill 3. Interpersonal skills necessary to work with patients (Art of Medicine) ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf Acquire AdvanceMaintain
ABMS Medical Professionalism Defining Redefining DebatingDeclaring Distributing Enforcing ACTIVE & ITERATIVE ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
ABMS Medical Professionalism Competencies • Commitment to carrying out professional responsibilities • Adherence to ethical principles • Demonstration of compassion, integrity and respect for others • Responsiveness to patient needs superseding self interests • Respect for patient privacy and autonomy • Accountability to patients, society and the profession • Sensitivity and responsiveness to a diverse patient population ABMS. ABMS Definition of Medical Professionalism. 2012. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
Medical Professionalism in Action Patients Trust MDs, MDs should show respect for human life. 1. Make the care of patient your first concern 2. Protect and promote health of patient and public 3. Provide good standard of practice and care A. Keep knowledge and skill up to date B. Recognize limits of competence C. Work with colleagues in patient’s best interest 4. Treat patients as individuals. Respect their dignity. A. Treat patients politely and considerately. B. Respect patient’s right to confidentiality. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding- Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar- Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
Medical Professionalism in Action Patients Trust MDs, MDs should show respect for human life. 5. Work in partnership with patients. A. Listen to patients, respond to concerns & preferences B. Give patients the information they want or need in a way they can understand C. Respect patients’ right to reach decisions with you about treatment & care D. Support patients in caring for themselves to improve and maintain their health 6. Be honest and open. Act with integrity. A. Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk B. Never discriminate unfairly against patients or colleagues C. Never abuse your patients’ trust in you or the public’s trust in the profession Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding- Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar- Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
68 Behavioral Signs of Professionalism 1. Practices in ethical manner 2. Honest 3. Discusses confidential information only with appropriate people 4. Good hygiene 5. Refers patients to appropriate specialists 6. Attention to cleanliness and comfort of patient areas 7. Maintains patient privacy during exams 8. Listens carefully 9. Answers questions from patients and families 10. Physically and psychologically fit for practice Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
68 Behavioral Signs of Professionalism 11. Works in patients best interest regardless of personal gain 12. Maintains appropriate behavior with patients and families 13. Seeks help when needed 14. Pays attention to detail 15. Takes genuine interest in patient’s health 16. Always gives best effort 17. Shows respect for patients and families 18. Communicates clearly and effectively 19. Takes responsibility for own actions and decisions 20. Keeps patient and/or family informed and up to date. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
68 Behavioral Signs of Professionalism 21. Follows up to ensure proper care. 22. Discusses confidential information in appropriate settings. 23. Delivers appropriate care regardless of patient’s personal characteristics 24. Communicates with other health professionals to coordinate care. 25. Prepares before seeing patient (e.g., reviews chart) 26. Explores patient’s needs and concerns 27. Open to patient getting a second opinion. 28. Shows compassion and care 29. Involves patient and/or family in decision-making 30. approachable Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
68 Behavioral Signs of Professionalism 31. Responds to phone calls, pages, emails in a timely manner 32. Controls own emotions and maintains composure 33. Personable and polite 34. Shows respect for physician colleagues 35. Greets patients appropriately 36. Tailors information to patient’s and family’s needs 37. Communicate orders clearly and effectively 38. Documents work that has been done 39. Maintains appropriate behavior with coworkers 40. Serves as patient advocate Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
68 Behavioral Signs of Professionalism 41. Shows respect for clinical and administrative staff 42. Keeps current with medical literature 43. Speaks respectfully about patients 44. Demonstrates team player mentality 45. Willing to admit mistakes 46. Admits when doesn’t know something 47. Use resources effectively and efficiently to optimize patient care 48. Willing to report impaired physicians 49. Answers questions from clinical and administrative staff 50. Speaks respectfully about other healthcare providers or specialties Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
68 Behavioral Signs of Professionalism 51. Shows sensitivity to different cultures 52. Will to take action if physicians deliver substandard care 53. Shows commitment to self- improvement and lifelong learning 54. Keeps time commitments or acknowledges waiting time. 55. Maintains professional behavior outside hospital or office [including social media] 56. Available to patients and families when needed 57. Takes patient’s values and situation into account 58. Serves as a positive role model 59. Dresses appropriately 60. Responds appropriately to constructive feedback Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
68 Behavioral Signs of Professionalism 61. Completes documentation and letters in a timely manner. 62. Keeps personal reactions to self 63. Provides constructive criticism to help solve problems 64. Balances personal needs and patient obligations 65. Encourages personal and professional growth of staff 66. Avoids nonscientific relationships with pharmaceutical companies 67. Shows awareness of test and treatment costs 68. Shows awareness of public health issues relevant to practice Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
Very Important Behaviors Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
Very Important Behaviors Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
https://doi.org/10.21315/eimj2017.9.1.9 Roslan NS, Yusoff MSB, 2017. Simplified Thematic Engagement of Professionalism Scale. Education in Medicine Journal 9(1): 87-97
98% of medical students report witnessing unprofessional behavior from faculty Feudner C, Crhistakis DA, Christakis NA. Do Clinical clerks suffer ethical erosion? Students perceptions of their ethical environment and personal development. Acad Med 1994: 69: 670-679.
Professionalism is a competency that needs to be achieved not only in medical education but also in practice. 1. References 6-16 of Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
Course of an EyeMD’s Career Entering the Profession Practicing the Profession Managing Professionally Leading the Profession Building on professionalism in partnership https://png2.kisspng.com https://www.accessnz.com
Students and doctors in training need to be exposed to the ESSENCE of MEDICAL PROFESSIONALISM first hand Learning not only from teachers, but also from colleagues and from the culture of institutions and organizations where they work. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros- Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
https://static1.squarespace.com https://cdn3.iconfinder.com
https://www2.deloitte.com RESIDENCY PRACTICE
Maintaining Ethics and Professionalism is a LIFETIME COMMITMENT Teaching Ethics and Professionalism is a LIFETIME COMMITMENT
“A true professional not only follows but loves the processes, policies and principles set by his profession.” ― Amit Kalantri, Wealth of Words
References 1. American Board of Medical Specialties. ABMS Definition of Medical Professionalism. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf. Acccessed 112518. 2. American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium-physician-charter. Accessed December 4, 2018. 3. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York, Oxford: Oxford University Press, 2013. 4. Commission on Higher Education Memorandum Order No. 18, Series of 2016. Policies, Standards, and Guidelines for the Doctor of Medicine (MD) Program. 5. Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi: https//doi.org/10.1136/bmj.b4716. 6. Feudner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad Med 1994: 69: 670-679. 7. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573. 8. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.. Accessed November 1, 2018 9. Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical Center)vol. 20,1 (2007): 13-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018 10. Levenson R, Dewar S, Shepherd S. Understanding doctors: harnessing professionalism. King’s Fund and RCP 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing- professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf. Accessed November 18, 2018. 11. Medical Ethics 101: What are the basic principles of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 12. Medical Protection Society. Professionalism: A Medical Protection Guide. https://mpscdnuks.azureedge.net/resources/docs/mp/publications/practice-matters/professionalism-a-medical-protection- guide.pdf. 13. NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December 2, 2018. 14. Rajaratnam V. Medical Professionalism Workshop 11 May 2013. https://www.slideshare.net/vaikunthan/medical-professionalism-workshop-11-may-2013. Accessed November 23, 2018. 15. Roslan NS, Yusoff MSB, 2017. Simplified Thematic Engagement of Professionalism Scale. Education in Medicine Journal 9(1): 87-97. https://doi.org/10.21315/eimj2017.9.1.9. Accessed November 1, 2018 16. Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC Med Ethics. 2014;15:73. Published 2014 Oct 7. doi:10.1186/1472-6939-15-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196023/. Accessed November 1 2018
What is Medical Professionalism? (What is Professionalism in Medicine?)

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What is Medical Professionalism? (What is Professionalism in Medicine?)

  • 1.
    What is MedicalProfessionalism? Alvina Pauline D. Santiago, MD December 7, 2018
  • 2.
    CHED: 10 ProgramOutcomes for Medicine 1. Clinical Competence 2. Communicate effectively 3. Lead and manage health care teams 4. Engage in research activities 5. Collaborate with interprofessional teams 6. Systems-based approach to healthcare 7. Continuing personal and professional development 8. Ethical, professional and legal standards 9. Nationalism, internationalism, dedication to service 10. Social accountability CHED Memorandum Order 18, Series of 2016. Policies, Standards and Guidelines for the Doctor of Medicine Program, https://ched.gov.ph/wp- content/uploads/2017/10/CMO-18-s.-2016.pdf. Accessed November 11, 2018.
  • 3.
    •Health Care Ethics •Bioethics •Setof moral principles, beliefs, and values that guide us in making choices about medical care From Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html. Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/
  • 4.
    • Evaluating meritsand difficulties of medical procedures • To be ethical must meet all 4 principles: • Autonomy • Justice • Beneficience • Non-maleficence Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/ 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
  • 5.
    Autonomy • Honor patient’sright to make own decision • Autonomy of thought, intention, action when making decisions • Free of coercion or coaxing • Fully informed consent • All risks and benefits declared • Likelihood of success 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
  • 6.
    Beneficence • For patient’sown good • Procedure provided with intent of doing good for patient • Physician should • develop and maintain skills and knowledge • Update training • Consider patient’s individual circumstances • Strive for net benefit 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
  • 7.
    Non-maleficence • Procedure doesnot harm • First do no harm 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 2. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
  • 8.
    Justice • Be fairand treat like cases alike • Burden and benefit of new procedures distributed equally among all groups in society • Uphold existing laws • Fair to all players involved 1. Fair distribution of scarce resources 2. Competing needs 3. Rights and obligations 4. Potential Conflicts with Existing laws 1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. 2. Medical Ethics 101: What are the basic priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
  • 9.
    Accreditation Council forGraduate Medical Education (ACGME) Core Competencies • Practice-based learning and improvement • Patient care and procedural skills • Systems-based practice • Medical Knowledge • Interpersonal and communication skills • Professionalism NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). January 12, 2017 https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December 2, 2018.
  • 10.
    ACGME: Professionalism Principles •Treat all people with respect, compassion, and dignity • Patient needs will supersede a resident’s self interest • Accept and understand accountability to patient, colleagues and society • Treating diverse patient population with sensitivity and respect. NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/
  • 11.
    ACGME: Professionalism Sub-competencies •Demonstrating professional conduct and accountability • Demonstrating humanism and cultural proficiency • Maintaining Emotional, physical and mental health • Pursuing continual personal and emotional growth NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/
  • 12.
    Medical Professionalism ACGME Core Competencies 1999 Medical Professionalism Project 1999 Professionalism Charter 2002 Adoptionby Major Physician Organizations Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical Center)vol. 20,1 (2007): 13-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018
  • 13.
    Professionalism Charter • Primacyof patient welfare • Altruism, trust, patient interest • “market forces, societal pressures and administrative exigencies” must NOT compromise this principle • Patient autonomy • Incorporates honesty • Educate and empower patients to make appropriate medical decisions • Social justice • Physician’s societal contract and distributive justice • Consider available resources and needs of all patients while taking care of individual patient American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium- physician-charter. Accessed December 4, 2018.
  • 14.
    Professionalism Charter A Setof Professional Responsibilities /Commitment • Professional competence • Honesty with patients • Patient Confidentiality • Maintaining appropriate relations with patients [and colleagues] • Improving quality of care • Improving access to care • Just distribution of finite resources • Scientific knowledge • Maintaining trust by managing conflicts of interest American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium- physician-charter. Accessed December 4, 2018.
  • 15.
  • 16.
    Medical Professionalism A setof values, behaviors, relationships that underpins the trust the public has in its physicians. • Integrity • Compassion • Altruism • Continuous improvement • Excellence • Partnership with healthcare team • Honor 1. Engel et al, Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi: https//doi.org/10.1136/bmj.b4716. 2. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573. 3. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings- Fund-May-2008_0.pdf. 4. Working Party of the Royal College of Physicians Clinical Med 2005 Nov-Dec; 5 (6 Suppl 1): S5-40.
  • 17.
    • Belief system •Profess to each other & public • Shared competency standards • Ethical values • Expectations ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
  • 18.
    ABMS Medical Professionalism 1.Ethical value system 2. Knowledge and technical skill 3. Interpersonal skills necessary to work with patients (Art of Medicine) ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf Acquire AdvanceMaintain
  • 19.
    ABMS Medical Professionalism Defining Redefining DebatingDeclaring Distributing Enforcing ACTIVE& ITERATIVE ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
  • 20.
    ABMS Medical ProfessionalismCompetencies • Commitment to carrying out professional responsibilities • Adherence to ethical principles • Demonstration of compassion, integrity and respect for others • Responsiveness to patient needs superseding self interests • Respect for patient privacy and autonomy • Accountability to patients, society and the profession • Sensitivity and responsiveness to a diverse patient population ABMS. ABMS Definition of Medical Professionalism. 2012. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
  • 21.
    Medical Professionalism in Action Patients TrustMDs, MDs should show respect for human life. 1. Make the care of patient your first concern 2. Protect and promote health of patient and public 3. Provide good standard of practice and care A. Keep knowledge and skill up to date B. Recognize limits of competence C. Work with colleagues in patient’s best interest 4. Treat patients as individuals. Respect their dignity. A. Treat patients politely and considerately. B. Respect patient’s right to confidentiality. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding- Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar- Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
  • 22.
    Medical Professionalism in Action Patients TrustMDs, MDs should show respect for human life. 5. Work in partnership with patients. A. Listen to patients, respond to concerns & preferences B. Give patients the information they want or need in a way they can understand C. Respect patients’ right to reach decisions with you about treatment & care D. Support patients in caring for themselves to improve and maintain their health 6. Be honest and open. Act with integrity. A. Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk B. Never discriminate unfairly against patients or colleagues C. Never abuse your patients’ trust in you or the public’s trust in the profession Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding- Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar- Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
  • 23.
    68 Behavioral Signsof Professionalism 1. Practices in ethical manner 2. Honest 3. Discusses confidential information only with appropriate people 4. Good hygiene 5. Refers patients to appropriate specialists 6. Attention to cleanliness and comfort of patient areas 7. Maintains patient privacy during exams 8. Listens carefully 9. Answers questions from patients and families 10. Physically and psychologically fit for practice Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
  • 24.
    68 Behavioral Signsof Professionalism 11. Works in patients best interest regardless of personal gain 12. Maintains appropriate behavior with patients and families 13. Seeks help when needed 14. Pays attention to detail 15. Takes genuine interest in patient’s health 16. Always gives best effort 17. Shows respect for patients and families 18. Communicates clearly and effectively 19. Takes responsibility for own actions and decisions 20. Keeps patient and/or family informed and up to date. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 25.
    68 Behavioral Signsof Professionalism 21. Follows up to ensure proper care. 22. Discusses confidential information in appropriate settings. 23. Delivers appropriate care regardless of patient’s personal characteristics 24. Communicates with other health professionals to coordinate care. 25. Prepares before seeing patient (e.g., reviews chart) 26. Explores patient’s needs and concerns 27. Open to patient getting a second opinion. 28. Shows compassion and care 29. Involves patient and/or family in decision-making 30. approachable Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 26.
    68 Behavioral Signsof Professionalism 31. Responds to phone calls, pages, emails in a timely manner 32. Controls own emotions and maintains composure 33. Personable and polite 34. Shows respect for physician colleagues 35. Greets patients appropriately 36. Tailors information to patient’s and family’s needs 37. Communicate orders clearly and effectively 38. Documents work that has been done 39. Maintains appropriate behavior with coworkers 40. Serves as patient advocate Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 27.
    68 Behavioral Signsof Professionalism 41. Shows respect for clinical and administrative staff 42. Keeps current with medical literature 43. Speaks respectfully about patients 44. Demonstrates team player mentality 45. Willing to admit mistakes 46. Admits when doesn’t know something 47. Use resources effectively and efficiently to optimize patient care 48. Willing to report impaired physicians 49. Answers questions from clinical and administrative staff 50. Speaks respectfully about other healthcare providers or specialties Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 28.
    68 Behavioral Signsof Professionalism 51. Shows sensitivity to different cultures 52. Will to take action if physicians deliver substandard care 53. Shows commitment to self- improvement and lifelong learning 54. Keeps time commitments or acknowledges waiting time. 55. Maintains professional behavior outside hospital or office [including social media] 56. Available to patients and families when needed 57. Takes patient’s values and situation into account 58. Serves as a positive role model 59. Dresses appropriately 60. Responds appropriately to constructive feedback Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 29.
    68 Behavioral Signsof Professionalism 61. Completes documentation and letters in a timely manner. 62. Keeps personal reactions to self 63. Provides constructive criticism to help solve problems 64. Balances personal needs and patient obligations 65. Encourages personal and professional growth of staff 66. Avoids nonscientific relationships with pharmaceutical companies 67. Shows awareness of test and treatment costs 68. Shows awareness of public health issues relevant to practice Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 30.
    Very Important Behaviors Green M,Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
  • 31.
    Very Important Behaviors Green M,Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566- 573.
  • 32.
    https://doi.org/10.21315/eimj2017.9.1.9 Roslan NS, YusoffMSB, 2017. Simplified Thematic Engagement of Professionalism Scale. Education in Medicine Journal 9(1): 87-97
  • 33.
    98% of medical studentsreport witnessing unprofessional behavior from faculty Feudner C, Crhistakis DA, Christakis NA. Do Clinical clerks suffer ethical erosion? Students perceptions of their ethical environment and personal development. Acad Med 1994: 69: 670-679.
  • 34.
    Professionalism is acompetency that needs to be achieved not only in medical education but also in practice. 1. References 6-16 of Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
  • 35.
    Course of an EyeMD’sCareer Entering the Profession Practicing the Profession Managing Professionally Leading the Profession Building on professionalism in partnership https://png2.kisspng.com https://www.accessnz.com
  • 36.
    Students and doctorsin training need to be exposed to the ESSENCE of MEDICAL PROFESSIONALISM first hand Learning not only from teachers, but also from colleagues and from the culture of institutions and organizations where they work. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros- Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf.
  • 37.
  • 38.
  • 39.
    Maintaining Ethics andProfessionalism is a LIFETIME COMMITMENT Teaching Ethics and Professionalism is a LIFETIME COMMITMENT
  • 40.
    “A true professionalnot only follows but loves the processes, policies and principles set by his profession.” ― Amit Kalantri, Wealth of Words
  • 41.
    References 1. American Boardof Medical Specialties. ABMS Definition of Medical Professionalism. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf. Acccessed 112518. 2. American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium-physician-charter. Accessed December 4, 2018. 3. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York, Oxford: Oxford University Press, 2013. 4. Commission on Higher Education Memorandum Order No. 18, Series of 2016. Policies, Standards, and Guidelines for the Doctor of Medicine (MD) Program. 5. Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi: https//doi.org/10.1136/bmj.b4716. 6. Feudner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad Med 1994: 69: 670-679. 7. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573. 8. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.. Accessed November 1, 2018 9. Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical Center)vol. 20,1 (2007): 13-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018 10. Levenson R, Dewar S, Shepherd S. Understanding doctors: harnessing professionalism. King’s Fund and RCP 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing- professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf. Accessed November 18, 2018. 11. Medical Ethics 101: What are the basic principles of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm 12. Medical Protection Society. Professionalism: A Medical Protection Guide. https://mpscdnuks.azureedge.net/resources/docs/mp/publications/practice-matters/professionalism-a-medical-protection- guide.pdf. 13. NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December 2, 2018. 14. Rajaratnam V. Medical Professionalism Workshop 11 May 2013. https://www.slideshare.net/vaikunthan/medical-professionalism-workshop-11-may-2013. Accessed November 23, 2018. 15. Roslan NS, Yusoff MSB, 2017. Simplified Thematic Engagement of Professionalism Scale. Education in Medicine Journal 9(1): 87-97. https://doi.org/10.21315/eimj2017.9.1.9. Accessed November 1, 2018 16. Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC Med Ethics. 2014;15:73. Published 2014 Oct 7. doi:10.1186/1472-6939-15-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196023/. Accessed November 1 2018