What is professionalism ?

Hallmarks of a professionCompetence in a specialized body of

knowledgeAcknowledgment of specific duties and

responsibilitiesAutonomy to train, admit, monitor, and

discipline its members; a privilege granted by society through licensure

Physicians must be:1. Altruistic2. Knowledgeable3. Skillful4. Dutiful

Less than 15 months after its

release, the Charter was

endorsed by more than 90 specialty

societies.

7

Clinical competence (knowledge)

Communication skills

Sound ethics

Excellence

Humanism

Accountability

Altruism

Professionalism

From: Stern D., ed. Measuring Professionalism (New York: Oxford University Press, 2006).

Patient expectionsIdeal physician behaviorsMayo Clin Proc. 2006;81:338-344.

192 patients in 14 specialty settings:Confident: engenders trustEmpathetic: “Understands my feelings”Humane: compassionate and kindPersonal: patient is a person, not a diseaseForthright: “Tells me what I need to

know”Respectful: “Takes my input seriously”Thorough: conscientious and persistent

Reasons for concernProfessionalism lapsesConflicts of interest among physicians

commonDeclining trust in the medical profession

Reasons for concernUnprofessional 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)

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

Professionalism is not simply innate.

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”

Should professionalism be taught? Yes.“Advancing Education in Medical Professionalism.” ACGME Outcome Project, 2004

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

16

Clinical competence (knowledge)

Communication skills

Sound ethics

Excellence

Humanism

Accountability

Altruism

Professionalism

From: Stern D., ed. Measuring Professionalism (New York: Oxford University Press, 2006).

Consider the elements of

professionalism.

Teaching professionalismMethods“Advancing Education in Medical Professionalism.” ACGME Outcome Project, 2004

LecturesDiscussion groupsRole plays, simulationExperiential (eg, clinical setting)Team learningRole modelingIndependent learning

Teaching professionalismStrategiesJAMA 2001;286:1067-1074

Establish a climate of humanismBe practical and relevantRecognize and use seminal eventsRole modelEncourage self-reflectionAddress the “hidden” curriculum

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.

“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.

Effective assessment of professionalism Stern D, ed. Measuring Professionalism; Oxford, 2006JAMA 2008;300:1326-1333

Multiple observers and instruments

Variety of settingsRealistic contextSituations that

involve conflictNot overly

stringent

Transparency; learners know purpose of assessment

Symmetry; all levels of the hierarchy are assessed

What do you do with the information?Formative feedbackSummative feedbackReward exemplarsEvaluate professionalism education programs

and generate research hypotheses

Using a “professionalism portfolio”