A National Survey: Medical Professionalism in Canadian Undergraduate Programs

1. A National Survey:Medical Professionalism in Canadian Undergraduate Programs Walter Hendelman MD MEd Anna Byszewski MD MEd FRCP(C)

2. UNIVERSITY OF OTTAWA PROFESSIONALISM REVIEW COMMITTEE • The Undergraduate Educational Evaluative Planning Strategy committee (UGEEPS) at University of Ottawa initiated a Program Review in 2006 • The undergraduate review consisted of 18 program reviews conducted from May 2006- January 2007 • The Professionalism Review Committee was charged with reviewing the undergraduate program in Medical Professionalism and generating recommendations • As part of needs assessment a national survey was conducted of programs across Canada

3. Methods • Primary contacts for professionalism programs at respective programs were identified – 17 individual institutions • Initial survey emailed fall 2006 • Second more detailed survey emailed winter 2007 with follow up emails and phone calls

5. YES Calgary Dalhousie (new separate program to be established) Manitoba McGill (linked) Memorial Northern Ontario Saskatchewan Sherbrooke Toronto (no humanities) U of Montreal (no humanities) Western (all three themes) UBC (together) NO Alberta Laval McMaster Ottawa Queen’s 1. Is professionalism part of Ethics and/or humanities?

6. YES Alberta Dalhousie Manitoba McGill McMaster Memorial Northern Ontario (password) Queen’s Saskatchewan (minimal) Toronto (under construction) UBC University of Montreal Western NO Calgary Laval Ottawa Sherbrooke 2. Website

7. YES Alberta Calgary Dalhousie Laval Manitoba McGill Memorial Northern Ontario Ottawa Queen’s (code developing in process) Saskatchewan Sherbrooke Toronto UBC Western NO McMaster University of Montreal 3. Does your faculty have an oath/code or guidelines?

8. 4. How and when is the oath/code transmitted to students Alberta: 3 codes during orientation and white coat Calgary: Welcome to Professionalism Ceremony in 1st trimester Dalhousie: Laval : with admission to the program Manitoba: Oath during inaugural / White Coat ceremony McGill: Code of conduct on day 1; Class oath 2nd year ceremony McMaster: n/a Memorial: introductory lectures Northern Ontario: Oath in first week Ottawa: Oath ceremony at end of orientation Queen’s:oath ceremony prior to clerkship Saskatchewan: First semester Sherbrooke: Code provided 1st trimester; White Coat preclerkship Toronto: orientation and clerkship oath UBC: Professionalism standards document signed during orientation (None on a website) University of Montreal: plans in place Western: n/a

9. YES: Alberta: at end of 2nd year Dalhousie: during orientation and and at graduation Laval:First session of first year ; a “cordon” given with ID Manitoba: at orientation week McGill: early in 2nd year McMaster: early in 1st year Memorial: early in 1st year Northern Ontario: Yes Ottawa: at end of orientation week Queen’s: prior to clerkship Saskatchewan: early in 1st year Sherbrooke: just before clerkship Toronto: orientation and clerkship Western: yes NO: Calgary University of Montreal UBC 5. Is there a white coat ceremony and when?

10. Alberta: YES, oath Calgary: student code of conduct Dalhousie: YES, Hippocratic oath Ottawa: YES, a declaration Manitoba: YES, Hippocratic oath McGill: YES McMaster: YES, a declaration Memorial: YES, oath of Geneva Northern Ontario: YES, a declaration Queen’s: YES, an oath Saskatchewan: YES, a declaration Toronto: YES, oath UBC: YES, Hippocratic oath University of Montreal: ? Western: YES Laval :NO Sherbrooke : NO 6. Does the ceremony include a reciting or professing of an oath?

11. 7a. Pre-clerkship activities Alberta: lectures, small group sessions, guest speakers and seminars Calgary: Culture, health & wellness course- year I &II, includes medical ethics, boundaries, stress and communication Dalhousie: ad hoc sessions, plans for formal incorporation in future Laval : A session in 1st and 2nd year and a video made by students Manitoba: Ethics course, communication skills course Professionalism I &II sessions McGill: didactic sessions, small group with cases, physician apprennticeship (Osler fellows) McMaster: Professional competencies curriculum within context of reflective 3 hour, weekly sessions with 2 preceptors over15 months Memorial: Helm lectures, small group sessions, assignments, plays, poems, stories, songs

12. 7b. Pre-clerkship activities Northen Ontario: case based scenarios, PBL evaluations q 6 weeks, MCQ on professionalism Ottawa: case based scenarios 2/year with faculty facilitators Queen’s: curriculum involving the doctor-patient relationship, ethics etc Saskatchewan: Professionalism course in the first year Sherbrooke: Obligatory lectures on ‘code of deontologie’ 3 week training with observation/training and 5 page paper + additional sessions (communication, humanism, ethics, legal) Toronto: professionalism program/ethics 42 hours UBC: part of two integrated themes – Ethics and Professionalism University of Montreal: 1.5 hour lecture to first year students + a short paper on a code of ethics for students Western: case scenarios+other sessions = 200 hours total over 4 years

13. YES Alberta: clinical problem series Dalhousie:1-hour lecture in intro to clerkship McMaster: PreComp integrated in all 8 rotations Northern Ontario: student driven case based scenarios Saskatchewan: expectations in yearly lecture series intro and referred to intermittently in AHD Toronto: 14 hours including Passport to Clerkship UBC: 4th year course CLEO University of Montreal (?) R1-R5 Western: academic half day & specialty specific seminar NO Calgary Laval Manitoba McGill (planning) Memorial Ottawa (under discussion plus Link prior to clerkship) Queen’s: ? Sherbrooke ? 8. Clerkship – is there official time devoted to professionalism

14. 9a. Evaluation forms Alberta: no formal evaluation, pending Calgary: Year I&II using Clinical Core forms, in clerkship specific section on professionalism Dalhousie: evaluation forms being revised to incorporate professionalism Laval: none Manitoba: using FITERS, can report on lapses in professionalism McGill: piloting new evaluations forms McMaster: part of the small group evaluation as submissions to the individual student portfolios Memorial ?

15. 9b. Evaluation forms Northern Ontario: PBL evaluation q 6 weeks+ MCQ on professionalism, pending for clerkship Ottawa: available for pre-clerkship, under review for clerkship Queen’s: available Saskatchewan: available, incorporated into clerkship evaluations Sherbrooke: available Toronto: available UBC: professional behavior assessed, both summative and formative University of Montreal: preclerkship form being revised Western: none

16. YES Calgary Dalhousie McGill McMaster Memorial Northern Ontario Ottawa Queen’s Saskatchewan Sherbrooke Toronto UBC (all programs have a remediation program) University of Montreal Western NO Alberta Laval Manitoba 10. Is passing professionalism component mandatory in pre-clerkship?

17. YES Alberta Calgary Dalhousie McGill McMaster Northern Ontario Ottawa Queen’s Saskatchewan Sherbrooke Toronto UBC (all programs have a remediation program) University of Montreal NO Laval Manitoba Memorial 11. Is passing the professionalism component mandatory in clerkship?

18. 12. Can a student be dismissed on basis of failing the professionalism component? • Most said YES • No: Laval and Manitoba

19. Calgary-MMI McMaster-specific stations MMI Northern Ontario-via multi station interview Sherbrooke-use TAAMUS test UBC-review portfolio/interview NO Alberta Dalhousie Laval (considering MMI) Manitoba McGill ?Memorial Ottawa Queen’s Saskatchewan Toronto University of Montreal ?Western 13. Is professionalism assessed as part of admission process?

20. 14a. Organization Alberta: Joint professionalism in the workplace and learning environment committee in the region Calgary: Professionalism ad hoc committee, Dalhousie: New Faculty of Medicine Professionalism committee Laval: Professionalism committee Manitoba: Director of Humanities – Professionalism, Ethics and Humanities McGill: Office of Curriculum Development and Physicianship Coordinating Committee McMaster:Professional Competency (ProComp) curriculum co chairs ( & domain planners group) Memorial: Curriculum coordinator for Humanities, Ethics and Law Northern Ontario: under Phase I chair

21. 14b. Organization Ottawa: Single chair of professionalism, committee being formed Queen’s: Working group on professionalism Saskatchewan: Clinical skills and professionalism sub-committee Sherbrooke: Professionalism MD committee Toronto: One person responsible for ethics and professionalism theme University of Montreal: Ethics committee responsible for preclerkship and clerkship Western: Leader Dr. J. Nisker has an assistant UBC: Theme Directors for Professionalism & Ethics + Ad Hoc advisory committee

22. Summary • Most sites have a code/declaration and a ceremony • Most sites have some professionalism teaching in the pre-clerkship curriculum • Some are starting to develop a clerkship curriculum • Professionalism competency is a requirement for passing pre-clerkship and clerkship at most sites

23. Recommendations for a professionalism program • Faculty: • need an official calendar with expectations of all members of staff • Teaching faculty: • aware of behavioural standards as role models • measures for evaluation • Students: • welcome to profession with an oath ceremony • educational activities, through preclerkship and clerkship • Evaluation • Organization: • Office of professionalism • Integration with teaching of Ethics and Humanities • Faculty development

24. Points for discussion • What do you see as some of the major barriers? • What works best?

25. Future directions • Unclear what is the faculty development at each site • What about the resident teaching? • More student involvement • Processes when problems arise are required • Websites and teaching/evaluation materials are developing and some are already available • Complete list of all national program contacts • List of oaths/resources on the AFMC website • Resources:http://www.afmc.ca/pages/sa_professionalism.html

26. Thank you for participating!!!