Education in Medicine System of Lifelong Training for Medical Schools Teachers

1. IM Sechenov First Moscow State Medical UniversityTempus IV 159328 - April 2012IIIrdInternational Conference Education in Medicine System of Lifelong Training for Medical Schools Teachers Professionalization of Medical Students Pr Sylvain Meuris Faculté de Médecine UniversitéLibre de Bruxelles

2. Profession : origin of term • Same Latin Root • - pro & fateor => To confess before (public) • - profiteor => To proclaim something publicly

3. Whatphysicians are professing ? • Physicians declare publicly two things • To be competent to help the patients • To have the patient’s best interests in mind • ‘Profession’ or declaration of commitment to an ideal to which he should conform

4. Whatphysicians are professing ? • Since centuries, physicians profess in two ways: • The public act of ‘oath taking’ • moment of transition to become a professional (≠ medical degree) • The doctor-patient relationship • This dialog represents an every day tacit commitment

5. Public expectation from practitioner • “… nothing is more estimable than a physician who, having studied nature from his youth, knows • the properties of the human body, • the diseases which assail it, • the remedies which will benefit it, • exercises his art with caution, and • pays equal attention to the rich and the poor.” Voltaire (1694-1778) • Bleeding and enema were the most prescribed therapeutic at this time !!!

6. What qualities are expected today from a physician ? From patients point of view • Reliable • Accessible • Dedicated • Honest • Accountable • Respect patient’s autonomy • Respect patient’s confidentiality • Non-judgemental • Compassionate • Confident • Composed From practitioners point of view • Knowledge • Altruism • Accountability • Respect • Integrity • Submission to an ethical code • Lifelong learning • Honesty • Compassion • Excellence • Self regulation

7. Are physicians attitudes & behavior always ideal • Plato (428-347 BC) described paradoxal types of doctor-patient relationships • (1) Medicine for 'free citizens’ : • ‘The physician treats their disease in a scientific way and takes the patient and his family into confidence,...’

8. Are physicians attitudes & behavior always ideal • (2) Plato contrasted this professional wisdom attitude with the medicine for ‘slaves’ • ‘The physician never listens from the slave any account of his complaints, nor asks for any; he gives some empiric treatment with an air of knowledge in the brusque fashion of a dictator, and then is off in haste to the next ailing slave.” • 1st historical description for a conflict of interest between patient and physician

9. Recent demystification of the medical profession Two great upheavals : • Medicine changed from an autonomous, publicly respected profession to one vilified in the public as in the media. Doctors had fallen from the pedestal of public adulation. • Health managers appeared to be potent rivals for the authority that physicians thought they owned.

10. Today situation We observed 4 paradoxes (Le Fanu, 1999) • Disillusioned doctors, seems more dissatisfied than in the past • Patient express health anxiety and dissatisfaction despite population health • Popularity of ‘alternative medicine’ contrast with the amazing success of modern medicine • Spiraling costs of health care need political control over medical decision making • This situation must induce profound changes and reforms in modern medical education. • Are medical schools able to adapt curricula to prepare physicians to correctly serve the population ?

11. An old question : Is excellence of medical education sufficient to prepare professionals ? • Should students work as physicians several years after studying medicine ? • Sir James Paget (1814-1899) St Bartholomew’s Hospital Reports, 5:238-242, 1869

12. Destiny of medical students (n=1000)

13. Among inactive physicians 1869 J Paget • 6 failed because of scandalous misconduct • 10 failed due to continued intemperance and dissipation • 10 failed through bad luck • 13 left or were expelled in disgrace • 3 were wisely removed by friends • 3 became actors • 2 retired because too rich

14. Professionalismduringmedicaleducation • Professionalism must be reached by attitude and behaviors that serve to maintain patient interest above physician self-interest • Evaluation of professional attitudes and behaviors forms a central but incompletely defined component of assessment across the medical education continuum

15. Analysis of formal medical training program topics • New meta-skills curricula must foster the acquisition of professionalism

16. Medical education is a continuum • From naïve and idealist student • Undergraduate learning • To experienced mature physician • Postgraduate training • Life Long Learning • Continuing professional development

17. Ideal learning and training program PROTO-PROFESSIONALISM NEW MEDICAL STUDENT MATURE PROFESSIONAL MATURITY PHRONESIS or SAGACITY EXPERIENCE SDL NAIVE PBL + ROLEMODELS Y1 Y2 Y3 Y4 Y5 Q Reg PGT Hilton and Slotnick

18. Hiden program PROTO-PROFESSIONALISM NEW MEDICAL STUDENT MATURE PROFESSIONAL BAD EXPERIENCES - ROLE MODELS FATIGUE CYNICAL IDEALISTIC POLITICS ADDICTIVE BEHAVIOURS Y1 Y2 Y3 Y4 Y5 Q Reg PGT • Hilton and Slotnick

19. Principles for the training to professionalism • Should begin early • Conducted frequently • Include many different assessors • Develop training for assessors • Implemented long-term • Use multiple methods in different settings • Provide learners with opportunities to change

20. Declaration of professionalism among medical student As a medical student, I recognize that I am now a member of the medical community. As such, I accept responsibility for my conduct, and expect the same of my colleagues. I will display these qualities in all academic and clinical settings. I do this as an essential part of my commitment to the provision of the highest standard of patient care, which is the central goal to which I am dedicated. I will demand these standards of myself and strive to support others to uphold them. Signed

21. Conclusion • Problems linked to professionalism are not new… • Medical schools must adapt curricula and provide lifelong learning to better prepare and help new physicians to answer society needs • Trust between physicians and patients must always prevail