seminar. Other faculty staff were asked to participatebased on their expertise in the various topics. Sessionswere interactive and devoted to the responses andconcerns of the interns. This approach was designedto engage the resident doctors (residents) onemotional and cognitive levels.What lessons were learned? A total of 12 internsparticipated. On a 5-point Likert scale on which1 = poor and 5 = outstanding, all sessions wereevaluated very positively: overall ratings for eachsession ranged between 4.6 and 5.0. Residents askedinsightful questions, such as: ‘How does one maintainappropriate boundaries with patients?’ ‘Why is thecurrent US health care system so fractured?’ ‘Why doAmericans accept such huge disparities in healthcare?’ ‘How could one create a system free from biasand with a climate of social justice?’ They suggestedthat additional time be allotted for exploring conflictsof interest for doctors in relation to industry and thetopic of health care finance. They were interestedin understanding the process of using doctors’ healthcommittees to assist doctors without breakingconfidentiality.

Residents value this interactive, educational expe-rience, which is aimed at enhancing and maintain-ing professionalism. They are ideal candidates fordeveloping and nurturing professionalism becausethey are in the process of becoming socialised asdoctors. In addition, they are key teachers ofmedical students and thus serve as role models.Having respected senior doctors model and teachkey issues of professionalism, and acknowledge thelifelong challenges of maintaining professionalism,is likely to have added to the success of thecurriculum.

Although all interns reported that curricular par-ticipation would have a positive impact on theirinteraction with patients and colleagues, our studywas not designed to assess the impact on the patient–doctor encounter, which would be the ultimateoutcome of interest. This was a labour-intensivecurriculum and required two faculty members toattend each session. Adding videos and personalnarratives of challenges in professionalism wouldincrease its curricular success. Future study shouldexamine the impact of a professionalism curriculumon actual resident behaviour and provide a moredetailed analysis of the impact of each topic.

REFERENCE

1 Hafferty FW. Beyond curriculum reform: confrontingmedicine’s hidden curriculum. Acad Med 1998;73:403–7.

Correspondence: Dr Kelly McGarry, Department of Internal Medicine,Alpert Medical School at Brown University, Jane Brown GroundFloor, 593 Eddy Street, Providence, Rhode Island 02905, USA.Tel: 00 1 401 444 5953; Fax: 00 1 401 444 3056;E-mail: kmcgarry@lifespan.org

doi: 10.1111/j.1365-2923.2012.04250.x

Medical professionalism adapted to faith andcultural beliefs

Dina El Metwally, Mona Azzam & Mai Abou Al-Seoud

What problems were addressed? Faith and culture-based ethics are integrated into daily life in theMiddle East. The inclusion of medical profession-alism into regional medical education curricula needsto be aligned with current medical practices,especially in relation to gender sensitivity,communication with veiled female doctors, patientservice and education during prayer time andRamadan (fasting month), faculty staff–trainee socialrelationships, and drug company funding of scientificactivities and international conference attendance.What was tried? A programme entitled ‘Students’Professional Practice and Accountability’ (SPPA)was developed to provide a basic foundation inknowledge and analytical skills in medical profession-alism for undergraduate and graduate students. It isalso intended to adapt established faith and culturalbeliefs to professional medical practices in order toenhance commitment to the health of individualsand society. The project was conducted at the KingFahd Armed Forces Hospital (KFAFH), Jeddah,Saudi Arabia. Participants included Year 5 medicalstudents in the Faculty of Medicine of KingAbdulaziz University, who rotate in the Departmentof Paediatrics at KFAFH, and residents in theDepartments of Paediatrics, and Obstetrics andGynaecology at KFAFH. The sessions were half-day,narrative and interactive small-group (six to 10trainees) classes. The critical incident technique wasapplied utilising two types of case: (i) simulated casesor vignettes adapted from standardised scenariossourced from the Accreditation Council for GraduateMedical Education, CanMEDS, American Board ofInternal Medicine and the Barry Challenges toProfessionalism questionnaire, and (ii) student-generated scenarios and incidents that are unique tolocal cultural practices.

The interactive sessions revealed gaps in overallknowledge of the attributes of professionalism(extent of altruism, defining integrity) and areas of

524 � Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 501–527

really good stuff

conflict in regard to threats to medical professional-ism (conflicts of interest versus opportunity; compe-tency versus respect). Discussion of issues unique tothe regional culture showed alignment with commu-nity norms and congruence with standards of pro-fessionalism and communication, for example,gender sensitivity and communication with veiledfemale practitioners. Faith-based practices, such asconducting prayers five times per day, were adaptedin a manner where fulfilling patients’ needs emergedas a priority even if prayers were missed at designatedtimes. Personal relationships and marriages amongfaculty staff and trainees did not follow standardprofessional codes and there was a consensus on theneed for educational and training institutions toenforce regulations in this area. Drug companysupport for scientific activities was generally consid-ered acceptable by trainees and was one of the topicsin which the SPPA programme had a strong impact inaltering common beliefs. Overall knowledge wasassessed using a pre- and post-intervention test.Preliminary results showed a mean pretest score of32.5% and a mean post-test score of 87.9%.What lessons were learned? The SPPA programmesignificantly increased awareness and knowledgeamong trainees of medical professionalism. Itrevealed a general alignment of faith and culturalpractices with standard medical professionalism.However, some areas, such as those pertaining topersonal relationships and drug company support,are to be regulated in order to adapt professionalbehaviour to culture-based norms. It is recommendedthat the SPPA programme be disseminated amongstudents and trainees on a wider national andregional scale.

Correspondence: Dr Dina El Metwally, Faculty of Medicine, MedicalEducation Department, Suez Canal University, Ismailia 41522,Egypt. Tel: 00 20 12 222 1049; Fax: 00 20 64 322 7426;E-mails: dmetwal@gmail.com, delmetwa.faimer@gmail.com

doi: 10.1111/j.1365-2923.2012.04249.x

Addressing complex multi-dimensional healthproblems using interprofessional education

Betsy VanLeit, Laura Banks & Cameron Crandall

What problems were addressed? Our academichealth centre has made a commitment tointerprofessional education (IPE) and teamworkacross the institution. However, each of ourprogrammes (medicine, nursing, pharmacy,occupational therapy, physical therapy and others)

educates its students in isolation in part as a result ofdifferent academic calendars and schedules. Toaddress the challenges inherent in incompatiblecourse calendars across colleges and schools,interprofessional faculty staff sought to identify waysto integrate an interprofessional and collaborativecomponent focused on complex health issues instudents’ education.What was tried? In 2010, we piloted a singleafternoon IPE session for 248 students from healthprofessional programmes. Students met in faculty-and staff-facilitated small groups to discuss acomplex case involving family violence, substanceuse and chronic pain, while considering the roles ofdifferent professionals and their contributions to thecase. Roving community experts answered questions.Groups gathered for a final discussion with anexpert panel, which answered questions andprovided case closure. The IPE event stimulatedlearning and course evaluations indicated a desirefor a more extensive interprofessional learningevent.

In 2011 with 274 students, we expanded the singleafternoon event to a 2-week curriculum with lecturesand small-group activities, as well as an onlineasynchronous component to supplement face-to-facegroup meetings. The case unfolded online over2 weeks. Video clips, simulated medical records andprintable resources were used to bring the case to life.Students read case materials, researched learningissues, discussed the case online, and produced agroup poster addressing one of several health issuesraised in the case. The course ended with studentsand faculty staff participation in a community expertpanel discussion of issues raised by the case.What lessons were learned? Although studentsdemonstrated significant increases in their ability torecognise and refer domestic violence and substanceuse, feedback on the learning process was mixed.Students felt rushed and did not find the onlinecomponent useful. Students wanted more face-to-facetime to learn about other professions and developinterprofessional skills. Feedback suggested that inone small group, the event had the effect ofstrengthening dislike and reinforcing stereotypes ofother professions. Comments in several groupsindicated that students still did not understand theroles and responsibilities of other professionalgroups.

Providing limited time together does notnecessarily result in better understanding of otherprofessions, and can actually serve to accentuatestereotypes and misunderstandings. It takes time forthe members of any team (professionals or students)to get to know and trust one another and IPE requires

� Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 501–527 525

really good stuff