Ms Liz Anderson & Dr Hayley Richards

1. Ms Liz Anderson & Dr Hayley Richards Changing our approach to assessing professional behaviour

2. Aims • Background – why is assessing “Professional Behaviour” an issue? • The University of Bristol approach to assessment • Case study example

3. Different discourses in medical education through the ages ……different definitions of in competence ??

4. Fitness to Practice? Societies’ expectations of what doctors are and what they changes and a contemporary discourse makes doctors accountable to the public in full view of the media spotlight

5. Doctors and Society “Until quite recently, the role of doctors in people’s lives…. were well understood. That is no longer the case. Social and political factors, together with the achievement and promise of medical science, have reshaped attitudes and expectations of both public and doctors.” Royal College of Physicians 2005

6. Good Medical Practice Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life. GMC May 2001

7. Promoting Professional Development • Explicit values/attitudes/behaviours that are repeatedly demonstrated in the learning environment • Curriculum should incorporate model of emotional as well as cognitive development • Mentorship should be encouraged • Reflective styles of teaching & learning promoted Howe, A. Medical Education 2002 Hilton & Slotnick, Medical Education 2005

8. Assessing Professional Behaviour • Little evidence for predictors at admission • Evaluation of attitudes and behaviours, like conscientiousness, good timekeeping, good record keeping, appear to be predictors • Self assessment relatively inaccurate Stern et al, Medical Education 2005 • Poorly performing doctors more likely to have exhibited attitudinal problems at medical school Papadakis et al 2004

9. Bristol Approach • Professional behaviour assessed on three dimensions: • Appearance • Attendance & punctuality • Attitude & behaviour

10. Students who fail professional behaviour ‘sub-standard professional behaviour results in a review of clinical knowledge’

11. Reflection Formative assessment Formative feedback Peer assessment Personal goal setting Direct observation Self-assessment Discussion Self-directed enquiry Role modelling The Remedial Placement: Assessment methods

12. The Remedial Placement: The Students • ‘disorganised casualness or an inability to grasp the significance of her behaviour’. • ‘in spite of his clear intellectual ability, he hasn’t been able to perform at an acceptable level’.

13. Reflection • ‘discuss professional issues in a safe environment, personalize them and, it is hoped, internalize them over the course of education and training’ Maudsley & Strivens 2003 • The insight gained becomes part of a larger body of knowledge described as tacit: that which one knows but cannot tell Polyani 1958 • Development of professional identity

14. Formative Assessment and Feedback

15. Formative Feedback

16. Formative Assessment and Feedback For feedback to be successful, • The student must possess a concept of the standard (or goal) being aimed for Sadler 1989 • The teacher must share the same concept of the goal Hounsell 1997

17. Formative Feedback: Constructivist model From: Juwah et al 2004 Enhancing Student Learning through Effective Formative Feedback

18. Peer Assessment • Correlate with faculty opinion • Stable over time • Halo effect • Individual level • Near-peer assessment • Multi-disciplinary

19. Student comments • ‘All students should have the opportunity to do this’ • ‘Memorising is not always the best way to learn’ • ‘I never thought much about what it really means to be a doctor’

20. Summary • Prioritize the teaching & assessment of professional behaviour from Year 1 upwards. • Reflection & formative feedback are powerful tools, but teachers may need more guidance. • Desired behaviours must be made explicit.