Development of Professionalism and Fitness to Practice

1. Development of Professionalism and Fitness to Practice Trudie Roberts Kathy Boursicot

2. 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

3. Professionalism in the 21st Century

4. 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

5. 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

6. The Present “A place of multiple realities” D.J. Cottrell 2000

8. The 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 how medicine responds

9. Present Challenges • The changing healthcare system • Issues of professional competence • Quality assurance

10. The Changing Healthcare System • The changing focus of patient treatment • The changing focus of illness • The changes in society* • The change in public expectations*

11. Changing value systems Libertarian Communitarian Utilitarian

12. The Changing Composition of Societies • Population movement • Globalisation and migration • Development of cultural diversity within geographical regions

13. The Change in Public Expectations • Consumer society • Empowerment • Choice • Informed public • Increased access to information • media

14. Competing models • Professionalism • Consumerism • Regulation • Management • Accountability

15. Changing world of work • Unique point in time – 4 distinct groups of workers • Duxbury 2002

16. Types • Traditionalists • Baby boomers • Generation X • Generation Y

17. Pre 1946 Traditionalists • Totally committed to the ‘company’ • Horrified by unemployment • Would go down with the ship • Typified by unquestioning loyalty

18. 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

19. 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

20. 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

21. How do each of these groups interpret professionalism?

22. Can professionalism survive?

24. 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

25. 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.

26. 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

28. 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

29. 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

30. 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

31. What do we mean by Professionalism? Six Domains: • Ethical practice • Reflection / self awareness • Responsibility for actions • Respect for patients • Working with others • Social responsibility

32. 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

34. NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM MATURITY PHRONESIS EXPERIENCE SDL NAIVE PBL +ve ROLE MODELS Y1 Y2 Y3 Y4 Y5 Q Reg  PGT O NAÏVE N

35. NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM IDEALISTIC BAD EXPERIENCES -ve ROLE MODELS FATIGUE CYNICAL POLITICS ADDICTIVE BEHAVIOURS Y1 Y2 Y3 Y4 Y5 Q Reg  PGT O NAÏVE N

36. 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

37. PERIOD OF PROTO-PROFESSIONALISM NEW MEDI- CAL STUDENT MATURE PROFESSIONAL ACQUISITION  DECAY  O NAÏVE N

38. 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

40. Behaviour~ skills/attitudes Does Knowshow Cognition~ knowledge Knows Showshow Model of competence Professional authenticity Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

41. Performance assessment in vivo: Work based assessment, Video, Audits Does Performance assessment in vitro: OSCE, SP-based test….. Knows how (Clinical) Context based tests: EMQ, essay type, oral….. Knows Factual tests: MCQ, essay type, oral….. Shows how Climbing the pyramid...... Does Shows how Knows how Knows

42. New skills emphasized • learning how to learn • self-appraisal • leadership • team skills • metacognition • professionalism • reflectiveness/reflexiveness…….

43. Does Does Shows how Knows how Knows how “Meta” skills Knows Knows Shows how Extending the pyramid

44. 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……..

45. How to assess “meta-skills”? • Basic method: Information gathering relying more on descriptiveand qualitative judgemental information

46. 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

47. Thank you