IM Sechenov First Moscow State Medical University Tempus IV 159328 - April 2012 III rd International...
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IM Sechenov First Moscow State Medical University Tempus IV 159328 - April 2012 III rd International Conference Education in Medicine System of Lifelong
IM Sechenov First Moscow State Medical University Tempus IV
159328 - April 2012 III rd International Conference Education in
Medicine System of Lifelong Training for Medical Schools Teachers
Professionalization of Medical Students Pr Sylvain Meuris Facult de
Mdecine Universit Libre de Bruxelles
Slide 2
Profession : origin of term EnglishRussianFrench
ProfessionProfession ProfessorProfesseur
ProfessionalismProfessionnalisme Same Latin Root - pro & fateor
=> To confess before (public) - profiteor => To proclaim
something publicly
Slide 3
What physicians are professing ? Physicians declare publicly
two things To be competent to help the patients To have the
patients best interests in mind Profession or declaration of
commitment to an ideal to which he should conform
Slide 4
What physicians 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
Slide 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 !!!
Slide 6
What qualities are expected today from a physician ? From
patients point of view Reliable Accessible Dedicated Honest
Accountable Respect patients autonomy Respect patients
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
Slide 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,...
Slide 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. 1 st historical
description for a conflict of interest between patient and
physician
Slide 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.
Slide 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 ?
Slide 11
Should students work as physicians several years after studying
medicine ? Sir James Paget (1814-1899) St Bartholomews Hospital
Reports, 5:238-242, 1869 An old question : Is excellence of medical
education sufficient to prepare professionals ?
Slide 12
Destiny of medical students (n=1000)
Slide 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
Slide 14
Professionalism during medical education 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
Slide 15
Analysis of formal medical training program topics
EmphasisedUnderemphasised o Science o Art o Expertise o
Professionalism o Bioscience o Humanism o Objective o Subjective o
Detachment o Empathy o Evidence-Based o Relationship-centered o
Specialism o Generalism o Hierarchy o Collegiality o
Intra-professionalism o Inter-professionalism New meta-skills
curricula must foster the acquisition of professionalism
Slide 16
Medical education is a continuum From nave and idealist student
Undergraduate learning To experienced mature physician Postgraduate
training Life Long Learning Continuing professional
development
Slide 17
NEW MEDICAL STUDENT MATURE PROFESSIONAL PROTO-PROFESSIONALISM
NAIVE PHRONESIS or SAGACITY Y1 Y2 Y3 Y4 Y5 Q Reg PGT PBL SDL
EXPERIENCE MATURITY + ROLE MODELS Hilton and Slotnick Ideal
learning and training program
Slide 18
NEW MEDICAL STUDENT MATURE PROFESSIONAL PROTO-PROFESSIONALISM
CYNICAL IDEALISTIC Y1 Y2 Y3 Y4 Y5 Q Reg PGT BAD EXPERIENCES
ADDICTIVE BEHAVIOURS - ROLE MODELS POLITICS FATIGUE Hilton and
Slotnick Hiden program
Slide 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
Slide 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
Slide 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
Slide 22
Domains of professionalism in medical education Personal
(intrinsic) attributes Ethical practice Reflection / self-awareness
Responsibility / accountability for actions commitment to
excellence, life-long learning and critical reasoning Co-operative
attributes Respect for patients Teamwork working with others Social
responsibility
Slide 23
Profession : To proclaim something publicly The essence of a
profession is the act of profession of commitment to an ideal to
which the professional should conform.
Slide 24
Check list to define a profession Practising requires formal
education Their members : Enjoy control over their own training
standards Have a journal devoted to its standards Possess
relatively high social status Have their own disciplinary
mechanisms Have secured protection from (1) state regulation as
well as from (2) market pressures Different from a vocation
Slide 25
Traditional learned professions By virtue of their Educational
breadth Importance in satisfying fundamental human need They have
been called learned professions This special status is reserved to
Medicine, Law, Ministry Other academic occupations
Slide 26
Present areas for professionalism Respect for patients Ethical
practice Reflection/self-awareness Responsibility commitment to
excellence & Life Long Learning Teamwork Social
responsibility
Slide 27
Criticism of physicians attitudes From India "Three kinds of
medical practitioners are found in this world; firstly, the
impostor in physician's robes; secondly, the vainglorious
pretenders and thirdly, those endowed with the true virtue of the
healer Charaka (120162 AD) in Ayurveda (the science of life)
Slide 28
Physicians possess their own disciplinary mechanisms ! Achilles
heel of the profession : Most professional bodies do not
effectively discipline their members; Most do not publish records
of their disciplinary actions, if any. This make it clear that
effective self- regulation is non-existent and needs to be created
if not too late.
Slide 29
Inactive physicians J Paget Failed entirely 15 never able to
pass exams due to idleness, listlessness or want of intellect 6
failed because of scandalous misconduct 10 due to continued
intemperance and dissipation shown as an undergraduate 10 through
bad luck Left the profession (n=96) 13 left or were expelled in
disgrace 3 were wisely removed by friends 3 became actors 3 became
homeopathic practitioners but without repute for wisdom or working
power 2 retired too rich to need to work