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What is professionalism ?

What is professionalism ?. Hallmarks of a profession. Competence in a specialized body of knowledge Acknowledgment of specific duties and responsibilities Autonomy to train, admit, monitor, and discipline its members; a privilege granted by society through licensure.

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What is professionalism ?

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  1. What is professionalism?

  2. Hallmarks of a profession • Competence in a specialized body of knowledge • Acknowledgment of specific duties and responsibilities • Autonomy to train, admit, monitor, and discipline its members; a privilege granted by society through licensure

  3. AAMCMedical School Objectives • Physicians must be: • Altruistic • Knowledgeable • Skillful • Dutiful

  4. ABIM/ACPCharter on Medical ProfessionalismAnn Intern Med 2002;136:243-246 and Ann Intern Med 2003;138:839-841 Less than 15 months after its release, the Charter was endorsed by more than 90 specialty societies.

  5. Professionalism Excellence Accountability Humanism Altruism Sound ethics Communication skills Clinical competence (knowledge) From: Stern D., ed. Measuring Professionalism (New York: Oxford University Press, 2006). 7

  6. Should professionalism be taught?

  7. Patient expectionsIdeal physician behaviorsMayo Clin Proc. 2006;81:338-344. 192 patients in 14 specialty settings: • Confident: engenders trust • Empathetic: “Understands my feelings” • Humane: compassionate and kind • Personal: patient is a person, not a disease • Forthright: “Tells me what I need to know” • Respectful: “Takes my input seriously” • Thorough: conscientious and persistent

  8. Reasons for concern • Professionalism lapses • Conflicts of interest among physicians common • Declining trust in the medical profession

  9. Reasons for concern • Unprofessional behavior in training associated with later disciplinary action by licensing boards (NEJM 2005;353:2673-2682) • Nearly all physician leaders and nurses have experienced disruptive physician behavior (Phys Exec 2004;Sept-Oct:6-14, Am J Nurs 2005;105:54-64, AORN J 2001;74:317-331)

  10. Consequences of disruptive physician behaviorhttp://cme.medscape.com/viewarticle/590319 • Reduced employee satisfaction, morale and productivity and increased employee turnover • Reduced communication, teamwork, and efficiency and increased costs • Decreased learner satisfaction, burnout, depression and unprofessional behavior

  11. Professionalism can be taught“Advancing Education in Medical Professionalism.” ACGME Outcome Project, 2004. • Formal and informal curricula influence professional attitudes and beliefs, moral reasoning, and behaviors • Role models influence attitudes and behavior; “hidden curriculum” Professionalism is not simply innate.

  12. We are a profession AAMC, ACGME, ABIM, and JCAHO recommendations and requirements Expectations of patients and society Formal and informal curricula influence professional attitudes and beliefs, moral reasoning, and behaviors Associated with important outcomes Should professionalism be taught? Yes.“Advancing Education in Medical Professionalism.” ACGME Outcome Project, 2004

  13. How do you teach professionalism?

  14. Professionalism Excellence Accountability Humanism Altruism Sound ethics Communication skills Clinical competence (knowledge) Consider the elements of professionalism. From: Stern D., ed. Measuring Professionalism (New York: Oxford University Press, 2006). 16

  15. Teaching professionalismMethods“Advancing Education in Medical Professionalism.” ACGME Outcome Project, 2004 • Lectures • Discussion groups • Role plays, simulation • Experiential (eg, clinical setting) • Team learning • Role modeling • Independent learning

  16. Teaching professionalismStrategiesJAMA 2001;286:1067-1074 • Establish a climate of humanism • Be practical and relevant • Recognize and use seminal events • Role model • Encourage self-reflection • Address the “hidden” curriculum

  17. Should professionalism be assessed? Yes. • Professionalism can be assessed (Stern DT. Measuring Professionalism; Oxford, 2006) • Formative and summative feedback • “They don’t respect what you expect; they respect what you inspect.” (Cohen JJ. Forward. In Measuring Professionalism; Oxford, 2006) • Evaluate education programs Failure to assess sends conflicting messages to learners, physicians, and patients.

  18. Assessing professionalismStern D, ed. Measuring Professionalism; Oxford, 2006 “Most practicing physicians observe each others’ behaviors only in the hallways and conference rooms--rarely with patients. The solution to this problem is to expand the number of observers and the settings in which they observe.

  19. Multiple observers and instruments Variety of settings Realistic context Situations that involve conflict Not overly stringent Transparency; learners know purpose of assessment Symmetry; all levels of the hierarchy are assessed Effective assessment of professionalism Stern D, ed. Measuring Professionalism; Oxford, 2006JAMA 2008;300:1326-1333

  20. What do you do with the information? • Formative feedback • Summative feedback • Reward exemplars • Evaluate professionalism education programs and generate research hypotheses Using a “professionalism portfolio”

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