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BYMOHAMMED O. AL-RUKBAN
GHAIATH HUSSEIN
Professionalism in Medicine
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Outline
What is professionalism?What constitutes professionalism?How to measure your
professionalism?
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Amateur Professional
Does it make any difference?
http://www.afmc.ca/pages/professionalism/1CruessSlides.ppt
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Definition
Professionalism in medicine requires the physician to serve the interests of the patient (and community) above his or her self-interest.
Professionalism aspires to altruism, accountability, excellence, duty, honour, integrity, and respect for other. (ABIM, 2000)
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Professionalism• Role of the doctor within
the health service– Understanding of the
health care system– Understanding of clinical
responsibilities– Appreciation of doctor as
researcher– Appreciation of doctor as
mentor or teacher– Appreciation of doctor as
manager including quality control
– Team working
• Personal Development– Lifelong Learner– Self awareness– Self confidence– Self regulation
• Self care• Self control• Personal time
management– Motivation
• Achievement drive• Commitment• initiative
– Career choice
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Elements of Professionalism
Altruism is the essence of professionalism. The best interest of the patients, not self-interest, is the rule.
Accountability is required at many levels - to individual patients, society and the profession…
Excellence entails a conscientious effort to exceed normal expectations and make a commitment to life-long learning…
Duty is the free acceptance of a commitment to service. Honour and integrity are the consistent regard for the
highest standards of behaviour and refusal to violate ones personal and professional codes.
Respect for others (patients and their families, other physicians and professional colleagues such as nurses, medical students, residents, subspecialty fellows, and self) is the essence of humanism…"
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10 commitments of professional doctor
to professional competenceto honesty with patientsto patients’ confidentialityto maintaining appropriate relationshipsto improving quality of careto improving access to careto a just distribution of finite resourcesto scientific knowledgeto maintaining trust by managing COI’sto professional responsibilities
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Commitments as a professional Medical Student
Respect for professors, preceptors, and peers Respect for guest speakers and visiting patients Respect for cadavers and anatomical specimens in
the anatomy lab Respect for the institution of which you are a part Respect for patients and their families at clinical
encounters Respect for patient confidentiality Respect for all members of the health care team Respect for administrative and support staffRespect for the core values of professionalism
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Lack of ProfessionalismSigns and Symptoms (ABIM, 2001)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);
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);
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Lack of Professionalism…cont.
Signs and Symptoms (ABIM, 2001)
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).
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How professionalism can be implemented?
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Professionalism and Curriculum Design
PerformanceOf Task
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Patient management
Knowledge
Practical procedures
Patient investigation
Clinical skills
Health promotion and Disease prevention
Decision making skills and clinicalreasoning and judgment
Basic, Social and clinical sciences
Personal Development& Lifelong Learning
Role of the doctor within the health service and community
PerformanceOf task
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How professionalism can be taught?
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Medical students & professionalism!
University of Toronto students reported:47% very frequently, frequently or occasionally had
been placed in a clinical situation where they felt pressure to act unethically
61% had witnessed a clinical teacher acting unethically
61% this happened very frequently, frequently or occasionally
Understanding the clinical dilemmas that shape medical student’s ethical development: questionnaire survey and focus group studyHicks, Lin, Robertson et al BMJ 2001;322:709-10
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How can We Teach Professionalism?
• Role Modeling• Bed Side Teaching• Simulated Patients• Small Group Discussions
We teach students the ideal, but they learn from the real
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Do that.. & Don’t do
that
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Follow Me
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How can professionalism be Assessed?
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Miller’s Triangle
Knows
Shows how
Knows how
Does
Pro
fess
iona
lism
Written, Oral orComputer based assessment
Performance or hands on assessmentPortfolios
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How can We Assess Professionalism?
• Peer Evaluation• Patient Surveys• Staff evaluations• Professionalism Portfolio (self evaluation)• 360 degree evaluation
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Evaluation aspect
Minor lapses,
Major lapses and
“Critical events”
Subject to judgment and hence a review process is in place.
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Minor lapses
Minor lapses are errors but have minimal consequences. Often there is no awareness of the unprofessional act or it occurs after the fact. There may often be mitigating circumstances.
Examples: 1. Student falls asleep on a stretcher in the hall of the
hospital. 2. Student does not meet deadline for paper due to
family illness but does not notify anyone.
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Major lapses
Major lapses are errors but have serious consequences. Often there is awareness of the unprofessional act . Usually, there are no mitigating circumstances.
Examples: 1. Student refuses to return phone calls and e-mails
from a professor. 2. Student does not answer his pager from the
emergency room3. Student rushes in to see a patient with “interesting”
findings despite being told to not do so.
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Critical events
Critical events are serious events that will require immediate action by the supervisor. It is a clear violation of the code of conduct.
Examples: 1. Student being dishonest either by lying or
misrepresenting himself/herself.2. Student hitting a patient. 3. Student being sexually inappropriate with a patient or
fellow member of the health care team.
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Assessment of Professionalism
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.
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Final Words
“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)
“Students tend to internalize and perpetuate the patterns of behaviour that surround them- the way they see
people treating each other and the way they themselves are treated”.
TS Inui
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