Professionalism

1. Professionalism Stephen Lytton Please interact with questions and opinions as much as possible There is a diversity of opinion- your opinions will be valuable. Discussion will help us develop our understanding?

2. Aims • Develop ideas on professionalism • Appreciate the difficulties in defining • Discuss personal strengths and weaknesses • Suggest a model to support you and help you further develop your professionalism • An advert for an enhanced role.

3. Video of Professionalism in the 1960’s • http://www.youtube.com/watch?v=oVWjAeAa52o • Group work-1 • 1- What makes a good doctor ? • 2-What makes a professional ? • 3-How do you link ?

4. Groups ideas • http://www.youtube.com/watch?v=6_DFcRiK0ZM • (GMC Video)

5. Definitions of Professionalism • Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and community served. • Epstein and Hundert 2002 (JAMA)

6. Important elements • Professionals are united by mastery of a complex body of knowledge and skills (to which RCGP adds Attitude). • They are also united by some degree of autonomy and self-regulation. With these privileges, however, comes a responsibility to adhere to society's expectation of professional practice. • Professionalism is, therefore, defined both by the medical world and by society at large and will continue to change. What are the current pressures?

7. “Threats” to Professionalism • Consumerism- (choice and Governments promises) • Emphasis on patients autonomy and rights • Attacks on professional self regulation • Stake holders (Expert groups……) • Technology • General Practice as a threatened business model • (Cultural, Social and Political).

8. Professionalism in Medicine • From the The Physician’s charter: • Primary patient welfare – Altruism, trust and patient interest. • Patient autonomy- Honesty, patient empowerment, education. • Social Justice- Using available resources, following standards of care, equity. (Medical professionalism in the new millennium Lancet 2002)

9. Group work -2 Video - ? Where we are heading http://www.youtube.com/watch?v=arCITMfxvEc 4- Thoughts on Humanism and Professionalism 5-How has professionalism changed and why. 6-Is reflection relevant and if so in what forms.

10. Humanism and Professionalism • Humanism (values) • -intrinsic set of deep-seated convictions about one’s obligations towards others. • Professionalism (behaviours) • Behaving in accordance to set of normative values and expectations (Cohen J Academic Medicine 2007)

11. Importance • Professionalism can lack essential humanistic qualities and be undermined when under duress OR when no one is watching. • (The tendency to revert to the doctor centred consultation,………..) • Humanism- who you are, drives authentic behaviours, harder to undermine when under stress, way of acting when no one watching- (? can we change- and can we encourage)

12. Enhancing Humanism • Identify the multiple perspectives in any encounter • Reflect on how these perspectives might converge or conflict. • Choosing to act altruistically. (Miller S Academic medicine 1999) Aim- Humanistic foundation, Professional behaviour, Patient centred. ? Optimal time to develop this in EOLC.

13. Group work 3 • Reflect on personal experiences Our Own, Peers and Senior colleagues – good experiences and those that have troubled us. Doctor- patient, doctor-doctor and teams Areas where we are unsure- use of the title doctor when not “working”, Facebook/Twitter and the Internet, signing documents, Government and other agencies demands and requests, CCG, Pharmaceutical industry. What do you think are your strengths and weaknesses. ? Extra ideas

14. Link to the Curriculum • GMC- Good Medical Practice 2013 • 4 domains • Knowledge skills and performance • Safety and quality • Communication, partnership and teamwork • Maintaining trust RCGP – 12 (generic) Competence areas for assessments And WONCA “tree” – six domains three contexts

15. Professional response • Reflect (on everything)- including writing. • Significant event discussions (positive and negative). • Professionalism is what you do (when everyone is looking) Humanism is who you are (when no one is looking) • Professionalism without humanism can be difficult to maintain. But also danger of humanism without professionalism with current training. Where are you at present?

16. My Personal View • Reflection ensures my development and stops me putting dressings over septic wounds (+Narrative) • RCGP Competence areas and their descriptors POSITIVELY guide me in my Professional actions- allowing me to understand the priorities, dilemmas and conflicts of interests. • GMC Guidance allows me to check my conclusions and support them (if I am correct- used before they tend to confuse me and be too legalistic- next slide more formal explanation).

17. General Medical Council • Good Medical Practice • sets out our professional responsibilities • tells us what to do and why they are important • Does not explain how to learn them!

18. An alternative model

19. A link to your training • Have you given constructive feedback to your trainers and P.D’s- on how to improve. If NOT then you are not fulfilling a role of professionalism. (p.s. we are good people to start with). • As trainers and PD’s- we will use WBPA’s (and CSA) to help you develop- I suggest aim to consider then as formative (>summative) for your Professionalism and Humanism . CSA is NOT a formulaic exam but tests “YOUR” Professionalism and Humanism.

20. An Advert • Surrey and Sussex LMC Needs YOU. • You can attend as a guest, with one of the members– (see website for members- include a number of Trainers). • You can become a member- meetings every other month on a Friday pm – (for which you will receive an honourariam).

21. Finally • Schön (have you heard of him) • On the high ground of professional practice (overlooking a swamp) … manageable problems lend themselves to solution through the application of research based theory (but danger of extrapolation!) • As GP’s we are often dealing with messy confusing problems defying technical solutions. Which are often more important to the individual and society. • As trainers we want to take you to the swamp- with uncertainties, conflicts, risks and mistakes.