Educating the Next Educating the Next Generation of Generation of

Medical ProfessionalsMedical ProfessionalsHelen O’SullivanHelen O’SullivanCentre for Excellence in Centre for Excellence in

Developing ProfessionalismDeveloping Professionalism

Medical SchoolMedical School

Outline of my talkOutline of my talk

Introduction: what is “medical Introduction: what is “medical professionalism”?professionalism”?

Why has medical professionalism Why has medical professionalism become so prominent?become so prominent?

How do we develop professionalism in How do we develop professionalism in medical undergraduates – The medical undergraduates – The Liverpool ProfessionalLiverpool Professional

Can we assess professionalism?Can we assess professionalism? Questions and discussionQuestions and discussion

What is Medical What is Medical Professionalism?Professionalism?

““Medical professionalism Medical professionalism signifies a set of values, signifies a set of values, behaviours, and relationships behaviours, and relationships that underpins the trust the that underpins the trust the public has in doctors.”public has in doctors.” RCP , Doctors in Society, 2005RCP , Doctors in Society, 2005

From the US, David Stern has From the US, David Stern has defined professionalism defined professionalism graphically:graphically:

Clinical Competence (Knowledge of Medicine)

Communication Skills

Ethical and Legal Understanding

Exce

llen

ce

Hu

man

ism

Acco

un

tab

ility

Altru

ism

Professionalism

Arnold and Stern, 2006

Hilton and Slotnik Hilton and Slotnik (2005)(2005)

Suggest six domains in which evidence of Suggest six domains in which evidence of professionalism can be expected:professionalism can be expected:Personal (intrinsic) attributes:Personal (intrinsic) attributes: Ethical practiceEthical practice Reflection and self awarenessReflection and self awareness Responsibility/accountability for actionsResponsibility/accountability for actions

Co-operative attributes:Co-operative attributes: Respect for patientsRespect for patients Working with othersWorking with others Social responsibilitySocial responsibility

Introduces us to phronesis Introduces us to phronesis and proto-professionalismand proto-professionalism

Emergence of Emergence of ProfessionalismProfessionalism

Combination of “lapses” of Combination of “lapses” of professionalism and growing professionalism and growing realisation of importance of realisation of importance of developing those skills and attributes developing those skills and attributes in undergraduate programmes. in undergraduate programmes.

Requirement for students to Requirement for students to demonstrate the development of demonstrate the development of professionalism in courses regulated professionalism in courses regulated by the GMCby the GMC

GMC Regulate Medical GMC Regulate Medical CurriculaCurricula

The principles of Good Medical Practice The principles of Good Medical Practice must underpin medical education:must underpin medical education:

Good clinical careGood clinical care Maintaining good medical practiceMaintaining good medical practice Relationships with patientsRelationships with patients Working with colleaguesWorking with colleagues Teaching and trainingTeaching and training ProbityProbity HealthHealth

Professionalism and the Professionalism and the Liverpool CurriculumLiverpool Curriculum

Recent review of the curriculum had as its Recent review of the curriculum had as its starting point:starting point:

Are Lifelong learnersAre Lifelong learners Have the ability to exercise leadership Have the ability to exercise leadership

skills and professional valuesskills and professional values Possess appropriate knowledge and skills Possess appropriate knowledge and skills

to deliver patient care and practise to deliver patient care and practise evidence-based medicineevidence-based medicine

Aspire to academic excellenceAspire to academic excellence

Professionalism has been a key feature of Professionalism has been a key feature of the curriculum for several yearsthe curriculum for several years Excellence recognised with the award Excellence recognised with the award

of the CETL in 2005. of the CETL in 2005.

The Liverpool The Liverpool ProfessionalProfessional

Values Patient Demeanour

Leadership Personal Motivation

•Ethics•Integrity•FTP•GMC•Human rights

•Empathy•Comm•Respect

•Appropriate manner•Attire•Comm•Internet image

•People management•Teaching•Comm•Teamwork•Leadership theory

•Critical thinking•Life-long learning•Career management•Action planning•Reflective practice•Excellence•Self management

•Altruism•Public service•Social responsibility•Caring•Patient interest/advocacy•Being part of a community of care•“privilege to help”

Can you Measure and Can you Measure and assess professionalism ?assess professionalism ?

Arnold 2002Arnold 2002 Suggested that there are three main ways of Suggested that there are three main ways of

assessing professionalism:assessing professionalism: Assessing component parts (e.g. communication)Assessing component parts (e.g. communication) Assessing professionalism as part of clinical Assessing professionalism as part of clinical

practicepractice Assessing professionalism as a comprehensive Assessing professionalism as a comprehensive

entityentity

““comprehensive entity” Difficult, complex comprehensive entity” Difficult, complex

Key Components of an Key Components of an Assessment StrategyAssessment Strategy

IntegratedIntegrated AuthenticAuthentic Promote excellencePromote excellence Challenges:Challenges:

Don’t simply measure that which is easy Don’t simply measure that which is easy to measureto measure

Language and sensitivityLanguage and sensitivity The hidden curriculumThe hidden curriculum Measuring attitudes and behaviourMeasuring attitudes and behaviour Don’t focus on FTPDon’t focus on FTP

Measuring Attitudes and Measuring Attitudes and BehaviourBehaviour

Difficult/ impossible to measure Difficult/ impossible to measure attitudesattitudes

Can measure:Can measure: Expressions of belief and behavioural Expressions of belief and behavioural

intentionsintentions Behavioural responses, physiological Behavioural responses, physiological

responsesresponses Skills Skills Observable behaviourObservable behaviour

Examples from our work: Examples from our work: “The Liverpool “The Liverpool Professional”Professional”

Introduce an Annual Student Introduce an Annual Student Feedback Appraisal Feedback Appraisal

Developing our outcomes into a Developing our outcomes into a electronic resource that students electronic resource that students can use as a annual self audit and can use as a annual self audit and preparation for appraisal preparation for appraisal

Using social networking philosophy Using social networking philosophy to engage students with reflection to engage students with reflection and professionalismand professionalism

What evidence do the students What evidence do the students bring to the appraisal? (Yr 1) bring to the appraisal? (Yr 1)

Formative examination results;Formative examination results; Multi source feedback comprising Multi source feedback comprising

contributions from:contributions from: PBL TutorsPBL Tutors Clinical Skills TutorsClinical Skills Tutors Communications Skills TutorsCommunications Skills Tutors Peers Peers

A structured reflective piece that they have A structured reflective piece that they have written for their PDPwritten for their PDP

A short task related to career managementA short task related to career management A self assessment of their current progress A self assessment of their current progress

towards “The Liverpool Professional”towards “The Liverpool Professional”

ReferencesReferences Sean R Hilton, Henry B Slotnick (2005) Proto-Sean R Hilton, Henry B Slotnick (2005) Proto-

professionalism: how professionalisation occurs professionalism: how professionalisation occurs across the continuum of medical education across the continuum of medical education Medical Medical EducationEducation 3939 (1), 58–65. (1), 58–65.

Arnold, Louise (2002) Assessing Professional Arnold, Louise (2002) Assessing Professional Behavior: Yesterday, Today, and TomorrowBehavior: Yesterday, Today, and Tomorrow. . Academic MedicineAcademic Medicine. . 7777(6):502-515 (6):502-515 

Arnold, L. & Stern, D. T. (2006) What is Medical Arnold, L. & Stern, D. T. (2006) What is Medical Professionalism? . IN STERN, D. T. (Ed.) Professionalism? . IN STERN, D. T. (Ed.) Measuring Measuring Medical Professionalism. .Medical Professionalism. . Oxford, Oxford University Oxford, Oxford University Press.Press.

The Royal College of Physicians Doctors in Society, The Royal College of Physicians Doctors in Society, RCP London, December 2005RCP London, December 2005