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Professionalism in GME: Defining and Measuring Professionalism. David T. Stern, MD, PhD Vice Chair for Professionalism Mount Sinai School of Medicine Albert Einstein College of Medicine 11 May 2010. Defining and Measuring Professionalism. What is (and is not) “professionalism” - PowerPoint PPT Presentation
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Professionalism in GME:Defining and Measuring
ProfessionalismDavid T. Stern, MD, PhD
Vice Chair for ProfessionalismMount Sinai School of Medicine
Albert Einstein College of Medicine11 May 2010
Defining and Measuring Professionalism
• What is (and is not) “professionalism”
• How can we measure something as “subjective” as professionalism?
• 4 measures of professionalism
What is a Profession?
• An occupation for which the necessary preliminary training is intellectual in character . . .
• . . . Pursued largely for others and not merely for one’s self
• . . . In which the amount of financial return is not the accepted measure of success.
Louis Brandeis, Brown University Commencement, 1912
What is a Professional?
• A professional has command of a special body of knowledge and skills.
• A professional is given specific rights not generally provided to the public.
• A professional has specific responsibilities or duties not generally expected of the public.
Cruess and Cruess 2000
Professionals have specialized knowledge and skills
• Physicians: Therapies, surgical procedures
• Lawyers: Details of the content and process of the law (local, state, and federal)
• Clergy: Religious ritual and scriptural interpretation
Professionals havespecific rights
• Physicians: Asking private questions, prescribing narcotics, performing operations
• Lawyers: Lawyer-Client privilege • Clergy: Participation, leadership,
and access to certain religious rituals
Common Elements
• Excellence• Humanism• Accountability• Altruism
Arnold L. Acad Med, May 2002.
Excellence
• A commitment to competence• Lifelong learning• Continuous quality
improvement• Promotion of scientific
knowledge
Humanism
• Caring, compassion, empathy• Honor and integrity• Respect for patients and their
families
Humanism
“Humanism is the passion that animates authentic professionalism. Humanism is a way of being. It comprises a set of deep-seated personal convictions about one’s obligations to others, especially others in need.”
Jordan Cohen, Acad Med 2007
Accountability
• “procedures and processes by which one party justifies and takes responsibility for its activities”
• Responsibility to: patients, families, society
• Accountability for: quality care, upholding principles, managing conflicts of interest
• Self and professional regulation
Altruism
• The interests of patients should guide behavior more than the interests of the individual physician.
• Can be part of excellence, humanism, or accountability
Clinical Competence (Knowledge of Medicine)
Communication Skills
Ethical and Legal Understanding
Exce
llen
ce
Hu
man
ism
Acco
un
tab
ility
Altru
ism
Professionalism
Arnold and Stern, 2006Arnold and Stern, 2006
. . . and wise application . . .
The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.
Martin Luther King Jr. Strength to Love, 1963
Three Ways to Promote Professionalism
• Expectations
• Experiences
• Evaluation
Stern and Papadakis, 2006
Defining and Measuring Professionalism
• What is (and is not) “professionalism”
• How can we measure something as “subjective” as professionalism?
• 4 measures of professionalism
How to Measure the “Subjective”
• Connoisseurship
• Criticism
• Choice
Connoisseurship
A means through which the complexities of situations can be noticed; it is a way of seeing what is subtle and significant.
Elliot Eisner
Criticism
The reeducation of perception. It is intended to illuminate through commentary or narrative what is subtle but significant in a situation so that those less sophisticated in a particular domain can come to see what they had not.
Elliot Eisner
Purpose of Measurement
To provide the tools with which you can convert connoisseurship into criticism in a formal and consistent manner.
Choice:For What Purpose are you
Measuring?
• To select (summative) Allows the comparison of students Provides information for feedback Could identify residents not fit to
practice• To improve (formative)
Does not allow for comparisons Intended purpose is for feedback More likely to be honest and critical
Defining and Measuring Professionalism
• What is (and is not) “professionalism”
• How can we measure something as “subjective” as professionalism?
• 4 measures of professionalism
Four Examples
• Administrative Data• Self-Evaluation• Faculty • Patients
Administrative Evaluations
• Cohort study of the entering Class of 1995 at University of Michigan medical school
• Question: What predicts professional behavior in the clinical years? Nothing from the admissions packet Evaluation completion Immunization compliance
Stern et al., 2005
Actual vs. Self Assessed Performance
0102030405060708090
100
1stQuartile
2ndQuartile
3rdQuartile
4thQuartile
ActualPerformanceSelf-AssessedPerformance
Stern et al., 2005
Faculty Evaluations
• Identified all Federation of State Medical Board sanctions for unprofessional behavior from graduates of 3 medical schools
• Selected 2 controls for each case by year of graduation and specialty
• Abstracted all student records, looking for any grades, indications or evaluations that comment on professionalism
AECOM Student Evaluation
• Professional Attributes Exhibits compassion, advocates for
his/her patients Reliability, attendance Willingness to “pitch in” Ability to bridge potential barriers of
social class, gender, ethnicity, disability Willingness to elicit and respond
constructively to feedback Overall interpersonal effectiveness
Predictive Validity of Faculty Evaluations
Papadakis, Teherani, Banach, Knettler, Rattner, Stern, Veloski, Hodgson, NEJM
2005
Important Types of Behavior
Patient Concerns
Cumulative Distribution of Physician Cohort Members and Unsolicited Complaints
Hickson GB, et al., JAMA. 2002;287:2951-2957.
Why Measure Professionalism?
• To identify a few in need • To honor and support many• To create a culture of professionalism
for all
And
• To ensure public trust
Special Thanks
• Arnold P. Gold Foundation for Humanism in Medicine• Institute on Medicine as a Profession• Research Collaborators:
University of California, San Francisco• Maxine Papadakis
University of Michigan• Alice Frohna, Barbara Kritt, Paul Gauger, Larry Gruppen, James
Woolliscroft University of Missouri, Kansas City
• Louise Arnold, Carrie Shue University of Toronto:
• Shiphra Ginsburg, Brian Hodges, Lorelei Lingard, Nancy McNaughton, Glenn Regehr
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