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WHAT PROFESSIONALISM CAN LEARN FROM

BIOCHEMISTRYSteven A. Wartman, MD, PhD, MACP

President/CEOAssociation of Academic Health Centers

Presented to the Professionalism Task Force of the University of South AlabamaApril 24, 2008

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Albert L. Lehninger (1917-1986)

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Hans A. Krebs (1900-1981)

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The “Krebs Cycle” Challenge

How can we ensure a common outcome in terms of progression of values for the incredibly varied group of individuals entering our education and training programs?

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The Learning Environment-1

• The Strong Forces– Accreditation– Testing– Licensure

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• Wartman SA, Littlefield JH. Changes in the US medical licensure examination and impact on US medical schools. Research Letter. JAMA 2005;293:424-425.

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The Learning Environment-2

• The Local Philosophy and Reality– Resources and priority– Faculty incentives– Traditional approach– Curriculum committee– Disciplinary pressure

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The Learning Environment-3

• Calls for new curricula 2001-2004– alternative therapies, bioterrorism,

cardiothoracic radiology, chronic illness, cross-cultural education, emergency psychiatry training, end-of-life care, geriatrics, medical humanities, musculoskeletal medicine, palliative care, stroke, and women’s health

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The Substrate-1

The students• Variety of perspectives, attitudes, skills,

motivation, personalities, beliefs, and even values

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The Substrate-2

• Service versus education conflict

• External Regulation

• Faculty and other role models

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“Culture eats strategy for lunch over and over again”

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Some Questions To Consider

• How do our health professions programs embrace and acculturate such a varied group of individuals?

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Some Questions To Consider

• How do we inculcate the idea of giving oneself in the service of others while learning?

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Some Questions To Consider

• Are we churning out superficially similar products that are able to pass the necessary board exams and go on with their careers, but who exhibit markedly different degrees of arguably the most important goal of health professions education: professionalization?

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Professionalism

• In the end professionalism means “acting rightly when the right path is clear before us but other pressing needs and desires pull us away… [and] taking the time and making the effort to do the right thing when the path of least resistance would be to take an easier way out…”1

• 1. Huddle TS. Teaching professionalism: is medical morality a competency? Acad

Med 2005;80(10):885-891.

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• What is not so apparent is the existence of a code of conduct that runs deep throughout the program and impacts the participants so that by graduation it has become part of their professional identity

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The Centrality Of Professionalism

• It’s what separates health professions education from a trade school

• It’s essential for the public trust

• It’s absolutely critical for the clinician-patient relationship

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So How Can Professionalism Be Taught?

• Not by using conventional means

• It is a long, slow and deliberate process that must be constantly reinforced

• It values the importance of personal experience and emotion in professional development

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The Challenge

• If our goal is to produce graduates deeply steeped in the ethos of professionalism, then our challenge is to find a common pathway to clinical practice that inculcates life long professionalism

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“It is indeed remarkable that all foodstuffs are burnt through a common pathway.”

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• In his Nobel Lecture of December 11, 1953, Krebs pointed out his “astonishment” that, in spite of a multitude of sources of energy, the number of steps where energy is utilized is small – only seven.

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Some Caveats

• This is not something that an orientation program or seminar will solve

• It requires an ongoing, constant commitment

• It starts from the top down

• And, it needs to be highly individualized and personalized

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The Seven Step Program

Step 1

• Model professionalism from the top down– Begin with the vice president, deans,

department chairs, program directors and eventually involve all the faculty

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The Seven Step Program

Step 2

• View professionalism as consistently important from day one to graduation– Be relentless

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The Seven Step Program

Step 3

• Get to know the individual student and trainee– Why? Because the transformation we seek is

a highly personal one

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The Seven Step Program

Step 4

• Build flexibility into your program– Each student and trainee has different needs,

strengths, weaknesses, etc– Eschew the “cookie cutter” approach

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The Seven Step Program

Step 5

• Provide regular and timely personal feedback and combine self-assessment with outside evaluation

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The Seven Step Program

Step 6

• Provide an ongoing safe venue to share experiences and enhance personal awareness

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The Seven Step Program

Step 7

• Commit your program to the provision of community service above and beyond the regular educational experiences

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“To have results you’ve never had, you must do things you’ve never done”

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“Out of the chaos of isolated reactions Krebs succeeded in extracting the basic system for the essential pathway of oxidation process within the cell.”

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“His penetrating intuition was so clear and true and his grasp of the problem so keen from the start that none of his original ideas had to be revised.”

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What will you do to step up to answer the call?