Workshop format
•Setting the scene – Professionalism in the 21st century
•Defining professionalism
•How to teach professionalism?
•How to assess professionalism and ensure fitness to practice?
•Summary
The Past
“The past is that part of eternity with some small fraction of which we have a slight and regrettable acquaintance”
A. Bierce from The Devil’s Dictionary
The past – ‘a golden age’
•Patients were passive and grateful
•Regulation of doctors was controlled by doctors themselves
•Public accountability was negligible
•Social prestige was high
The PresentThe Present
• A time of unprecedented change
• No return to the golden age
• A questioning society
• Professions including medicine have lost status
• Professionalism is the key to public trust
• The future will depend in part on howmedicine responds
Present Challenges
• The changing healthcare system• Issues of professional competence• Quality assurance
The Changing Healthcare System
•The changing focus of patient treatment
•The changing focus of illness
•The changes in society*
•The change in public expectations*
The Changing Composition of Societies
•Population movement• Globalisation and migration• Development of cultural diversity within
geographical regions
The Change in Public Expectations
•Consumer society
•Empowerment
•Choice
• Informed public• Increased access to information• media
Pre 1946 Traditionalists
•Totally committed to the ‘company’
•Horrified by unemployment
•Would go down with the ship
•Typified by unquestioning loyalty
1947- 1972 Baby Boomers
•Workaholics
•Accept stress as part of the job
•Used to belt tightening and sacrifice
•Work predicated on delayed gratification
•Value titles and status symbols
1968 – 1980 Generation X
•Place more importance on career than personal life
•Mistrustful and suspicious of employers•Products of downsizing and cost
cutting•Usually had experience of many jobs•Not committed to a particular company•Want immediate gratification
1980 – 1995 Generation Y
• Want a balance of work and personal life
• Take time off for personal life enhancement
• Demand flexible environments and benefits
• Do not expect a job for life
• Expanding job market and shrinking work force
• Expect and get immediate reward
The Future
“The future is that period of time in which our affairs prosper, our friends are true, and our happiness is assured”
A. Bierce from The Devil’s Dictionary
The Social Contract hinges on professionalism. To preserve medicine’s values in changing
times, it is essential for physicians to understand professionalism and the
obligations required to sustain it.
Workshop format
•Setting the scene – Professionalism in the 21st century
•Defining professionalism•How to teach professionalism
•How to assess professionalism and ensure fitness to practice
•Summary
Definitions (1)• UK’s GMC
• Duties of a Doctor• Good Medical Practice
• CanMEDS• Medical expert, communicator,
collaborator, manager, health advocate, scholar, professional
• ABIM/ACP/EFIM – “A Physician Charter”• Patient welfare• Patient autonomy• Social justice
Definitions (2)
•Swick• Need for a definition• 9 professional behaviours
•Cruess & Cruess• Physician as Healer / as Professional• Damaged social contract
•Cosgrove• Professionalism – state not trait
Definitions (3)
•Calman “The Profession of Medicine”• High ethical standards• CPD, change and improvement, R&D• Teamwork• Health as well as illness• Concern with clinical effectiveness &
outcomes• Ability to communicate
What do we mean by Professionalism?
Six Domains:
• Ethical practice
• Reflection / self awareness
• Responsibility for actions
• Respect for patients
• Working with others
• Social responsibility
Workshop format
•Setting the scene – Professionalism in the 21st centuary
•Defining professionalism
•How to teach professionalism?
•How to assess professionalism and ensure fitness to practice?
•Summary
NEW MEDICAL STUDENT
MATURE PROF-
ESSIONAL
PERIOD OF PROTO-PROFESSIONALISM
O NAÏVE N
NAIVE
PHRONESIS
Y1 Y2 Y3 Y4 Y5 Q Reg PGT
PBL
SDLEXPERIENCE
MATURITY
+ve ROLEMODELS
NEW MEDICAL STUDENT
MATURE PROF-
ESSIONAL
PERIOD OF PROTO-PROFESSIONALISM
O NAÏVE N
CYNICAL
IDEALISTIC
Y1 Y2 Y3 Y4 Y5 Q Reg PGT
BAD EXPERIENCES
ADDICTIVE BEHAVIOURS
-ve ROLE MODELS
POLITICS
FATIGUE
How Can Professionalism Be Taught?
• Role Models • Didactics on History of Medicine, Self-
Regulation and Public Policy• Small Group Discussions• Grand Rounds• Named Lectures• Teaching ward rounds • Clinical Vignettes• Reflective Exercises• Self-Assessment/Narratives
NEW MEDI- CAL STUDENT
MATUREPROFESSIONAL
PERIOD OF PROTO-PROFESSIONALISM
O NAÏVE N
DECAY
ACQUISITION
Workshop format
•Setting the scene – Professionalism in the 21st century
•Defining professionalism
•How to teach professionalism?
•How to assess professionalism and ensure fitness to practice?
•Summary
Knows
Knows how
Shows how
Behaviour~ skills/attitudes
Cognition~ knowledge
Model of competence
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.
Does
Pro
fess
ion
al
auth
enti
city
Climbing the pyramid......
Knows
Shows how
Knows how
Does
Knows Factual tests: MCQ, essay type, oral…..
Knows how (Clinical) Context based tests:EMQ, essay type, oral…..
Shows how Performance assessment in vitro:OSCE, SP-based test…..
DoesPerformance assessment in vivo:Work based assessment, Video, Audits
New skills emphasized
• learning how to learn
•self-appraisal
• leadership
• team skills
•metacognition
•professionalism
• reflectiveness/reflexiveness…….
How to assess “meta-skills”?
•Self assessment•Peer assessment•Co-assessment (combined self, peer,
teacher assessment)
•Patient ratings•Log book/diary•Structured evaluations (mini cex
etc)•Portfolio assessment……..
How to assess “meta-skills”?
Basic method: Information gathering relying more on descriptive and qualitative judgemental information
Workshop format
•Setting the scene – Professionalism in the 21st centuary
•Defining professionalism
•How to teach professionalism
•How to assess professionalism and ensure fitness to practice
•Summary