A National Survey:A National Survey:Medical Professionalism in Medical Professionalism in Canadian Undergraduate Canadian Undergraduate

ProgramsProgramsWalter Hendelman MD MEdWalter Hendelman MD MEd

Anna Byszewski MD MEd FRCP(C)Anna Byszewski MD MEd FRCP(C)

UNIVERSITY OF OTTAWA UNIVERSITY OF OTTAWA PROFESSIONALISM REVIEW COMMITTEEPROFESSIONALISM REVIEW COMMITTEE

The Undergraduate Educational Evaluative The Undergraduate Educational Evaluative Planning Strategy committee (UGEEPS) at Planning Strategy committee (UGEEPS) at University of Ottawa initiated a Program Review University of Ottawa initiated a Program Review in 2006in 2006

The undergraduate review consisted of 18 program The undergraduate review consisted of 18 program reviews conducted from May 2006- January 2007reviews conducted from May 2006- January 2007

The Professionalism Review Committee was The Professionalism Review Committee was charged with reviewing the undergraduate charged with reviewing the undergraduate program in Medical Professionalism and program in Medical Professionalism and generating recommendationsgenerating recommendations

As part of needs assessment a national survey was As part of needs assessment a national survey was conducted of programs across Canadaconducted of programs across Canada

MethodsMethods

Primary contacts for professionalism Primary contacts for professionalism programs at respective programs were programs at respective programs were identified – 17 individual institutionsidentified – 17 individual institutions

Initial survey emailed fall 2006Initial survey emailed fall 2006 Second more detailed survey emailed winter Second more detailed survey emailed winter

2007 with follow up emails and phone calls2007 with follow up emails and phone calls

1. Is professionalism part of Ethics 1. Is professionalism part of Ethics and/or humanities?and/or humanities?

YESYESCalgaryCalgaryDalhousie Dalhousie (new separate program to (new separate program to

be established)be established)ManitobaManitobaMcGill (linked)McGill (linked)MemorialMemorialNorthern OntarioNorthern OntarioSaskatchewanSaskatchewanSherbrookeSherbrookeToronto Toronto (no humanities)(no humanities)U of Montreal U of Montreal (no humanities)(no humanities)Western Western (all three themes)(all three themes)UBC (together)UBC (together)

NONOAlbertaAlbertaLaval Laval McMasterMcMasterOttawaOttawaQueen’sQueen’s

2. Website2. WebsiteYESYESAlbertaAlbertaDalhousieDalhousieManitobaManitobaMcGillMcGillMcMasterMcMasterMemorialMemorialNorthern Ontario Northern Ontario (password)(password)Queen’sQueen’sSaskatchewan Saskatchewan (minimal)(minimal)Toronto Toronto (under construction)(under construction)UBCUBCUniversity of MontrealUniversity of MontrealWesternWestern

NONOCalgaryCalgaryLavalLavalOttawaOttawaSherbrookeSherbrooke

3. Does your faculty have an oath/code or 3. Does your faculty have an oath/code or guidelines?guidelines?

YESYESAlbertaAlbertaCalgary Calgary DalhousieDalhousieLavalLavalManitoba Manitoba McGillMcGillMemorialMemorialNorthern OntarioNorthern OntarioOttawaOttawaQueen’s (code developing in Queen’s (code developing in

process)process)SaskatchewanSaskatchewanSherbrookeSherbrookeTorontoTorontoUBCUBCWesternWestern

NONOMcMasterMcMasterUniversity of MontrealUniversity of Montreal

4. How and when is the oath/code 4. How and when is the oath/code transmitted to studentstransmitted to students

Alberta:Alberta: 3 codes during orientation and white coat 3 codes during orientation and white coatCalgary:Calgary: Welcome to Professionalism Ceremony in 1 Welcome to Professionalism Ceremony in 1stst trimester trimesterDalhousie:Dalhousie:Laval : Laval : with admission to the programwith admission to the programManitoba:Manitoba: Oath during inaugural / White Coat ceremony Oath during inaugural / White Coat ceremonyMcGill: Code of conduct on day 1; Class oath 2McGill: Code of conduct on day 1; Class oath 2ndnd year ceremony year ceremonyMcMaster: n/aMcMaster: n/aMemorial:Memorial: introductory lectures introductory lecturesNorthern Ontario:Northern Ontario: Oath in first week Oath in first weekOttawa:Ottawa: Oath ceremony at end of orientation Oath ceremony at end of orientationQueen’s:Queen’s:oath ceremony prior to clerkshipoath ceremony prior to clerkshipSaskatchewan: Saskatchewan: First semesterFirst semesterSherbrooke:Sherbrooke: Code provided 1 Code provided 1stst trimester; White Coat preclerkship trimester; White Coat preclerkshipToronto: Toronto: orientation and clerkship oathorientation and clerkship oathUBC:UBC: Professionalism standards document signed during orientation Professionalism standards document signed during orientation

(None on a website)(None on a website)University of Montreal: University of Montreal: plans in placeplans in placeWestern: Western: n/an/a

5. Is there a white coat ceremony and 5. Is there a white coat ceremony and when?when?

YES:YES:Alberta:Alberta: at end of 2 at end of 2ndnd year yearDalhousie: Dalhousie: during orientation and and at during orientation and and at

graduationgraduationLaval:Laval:First session of first year ; a First session of first year ; a

“cordon” given with ID“cordon” given with IDManitoba:Manitoba: at orientation week at orientation weekMcGill:McGill: early in 2 early in 2ndnd year yearMcMaster: McMaster: early in 1early in 1stst year yearMemorial:Memorial: early in 1 early in 1stst year yearNorthern OntarioNorthern Ontario: Yes: YesOttawa:Ottawa: at end of orientation week at end of orientation weekQueen’s:Queen’s: prior to clerkship prior to clerkshipSaskatchewan: Saskatchewan: early in 1early in 1stst year yearSherbrookeSherbrooke: just before clerkship: just before clerkshipToronto: Toronto: orientation and clerkshiporientation and clerkshipWesternWestern: yes: yes

NO:NO:CalgaryCalgaryUniversity of MontrealUniversity of MontrealUBCUBC

6. Does the ceremony include a 6. Does the ceremony include a reciting or professing of an oath?reciting or professing of an oath?

Alberta:Alberta: YES, oath YES, oathCalgary: Calgary: student code of conductstudent code of conductDalhousie: Dalhousie: YES, Hippocratic oathYES, Hippocratic oathOttawa:Ottawa: YES, a declaration YES, a declarationManitoba: Manitoba: YES, Hippocratic oathYES, Hippocratic oathMcGill:McGill: YES YESMcMaster: McMaster: YES, a declarationYES, a declarationMemorialMemorial: YES, oath of Geneva: YES, oath of GenevaNorthern Ontario:Northern Ontario: YES, a declaration YES, a declarationQueen’s: Queen’s: YES, an oathYES, an oathSaskatchewan: Saskatchewan: YES, a declarationYES, a declarationToronto: Toronto: YES, oathYES, oath UBC: UBC: YES, Hippocratic oath YES, Hippocratic oath University of Montreal: ?University of Montreal: ?WesternWestern: YES: YES

LavalLaval :NO :NOSherbrooke Sherbrooke : NO: NO

7a. Pre-clerkship activities7a. Pre-clerkship activitiesAlberta:Alberta: lectures, small group sessions, guest speakers and seminars lectures, small group sessions, guest speakers and seminarsCalgary:Calgary: Culture, health & wellness course- year I &II, includes Culture, health & wellness course- year I &II, includes

medical ethics, boundaries, stress and communicationmedical ethics, boundaries, stress and communicationDalhousie: Dalhousie: ad hoc sessions, plans for formal incorporation in futuread hoc sessions, plans for formal incorporation in futureLaval :Laval : A session in 1 A session in 1stst and 2 and 2ndnd year and a video made by students year and a video made by studentsManitobaManitoba: Ethics course, communication skills course : Ethics course, communication skills course

Professionalism I &II sessionsProfessionalism I &II sessionsMcGillMcGill: didactic sessions, small group with cases, physician : didactic sessions, small group with cases, physician

apprennticeship (Osler fellows)apprennticeship (Osler fellows)McMaster: McMaster: Professional competencies curriculum within context of Professional competencies curriculum within context of

reflective 3 hour, weekly sessions with 2 preceptors over15 reflective 3 hour, weekly sessions with 2 preceptors over15 monthsmonths

Memorial:Memorial: Helm lectures, small group sessions, assignments, plays, Helm lectures, small group sessions, assignments, plays, poems, stories, songspoems, stories, songs

7b. Pre-clerkship activities7b. Pre-clerkship activitiesNorthen OntarioNorthen Ontario: case based scenarios, PBL evaluations q 6 : case based scenarios, PBL evaluations q 6

weeks, MCQ on professionalismweeks, MCQ on professionalismOttawa:Ottawa: case based scenarios 2/year with faculty facilitators case based scenarios 2/year with faculty facilitatorsQueen’s:Queen’s: curriculum involving the doctor-patient relationship, curriculum involving the doctor-patient relationship,

ethics etcethics etcSaskatchewan: Saskatchewan: Professionalism course in the first year Professionalism course in the first year SherbrookeSherbrooke: Obligatory lectures on ‘code of deontologie’ : Obligatory lectures on ‘code of deontologie’

3 week training with observation/training and 5 page paper + 3 week training with observation/training and 5 page paper + additional sessions (communication, humanism, ethics, legal)additional sessions (communication, humanism, ethics, legal)

Toronto: Toronto: professionalism program/ethics 42 hoursprofessionalism program/ethics 42 hoursUBC: UBC: part of two integrated themes – Ethics and Professionalismpart of two integrated themes – Ethics and ProfessionalismUniversity of Montreal: University of Montreal: 1.5 hour lecture to first year students 1.5 hour lecture to first year students

+ a short paper on a code of ethics for students+ a short paper on a code of ethics for studentsWestern:Western: case scenarios+other sessions = 200 hours total over 4 case scenarios+other sessions = 200 hours total over 4

yearsyears

8. Clerkship – is there official time 8. Clerkship – is there official time devoted to professionalismdevoted to professionalism

YESYESAlberta: clinical problem seriesAlberta: clinical problem seriesDalhousie:1-hour lecture in intro to Dalhousie:1-hour lecture in intro to

clerkshipclerkshipMcMaster: PreComp integrated in all McMaster: PreComp integrated in all

8 rotations8 rotationsNorthern Ontario: student driven Northern Ontario: student driven

case based scenarioscase based scenariosSaskatchewan: expectations in yearly Saskatchewan: expectations in yearly

lecture series intro and referred to lecture series intro and referred to intermittently in AHDintermittently in AHD

Toronto: 14 hours including Passport Toronto: 14 hours including Passport to Clerkshipto Clerkship

UBC: 4UBC: 4thth year course CLEO year course CLEOUniversity of Montreal (?) R1-R5University of Montreal (?) R1-R5Western: academic half day & Western: academic half day &

specialty specific seminarspecialty specific seminar

NONOCalgaryCalgaryLavalLavalManitobaManitobaMcGill (planning)McGill (planning)MemorialMemorialOttawa (under discussion plus Ottawa (under discussion plus

Link prior to clerkship)Link prior to clerkship)Queen’s: ?Queen’s: ?Sherbrooke ?Sherbrooke ?

9a. Evaluation forms9a. Evaluation forms

AlbertaAlberta: no formal evaluation, pending: no formal evaluation, pendingCalgaryCalgary: Year I&II using Clinical Core forms, in clerkship : Year I&II using Clinical Core forms, in clerkship

specific section on professionalismspecific section on professionalismDalhousie: Dalhousie: evaluation forms being revised to incorporate evaluation forms being revised to incorporate

professionalismprofessionalismLaval: Laval: nonenoneManitobaManitoba: using FITERS, can report on lapses in : using FITERS, can report on lapses in

professionalismprofessionalismMcGillMcGill: piloting new evaluations forms: piloting new evaluations formsMcMaster: McMaster: part of the small group evaluation as submissions part of the small group evaluation as submissions

to the individual student portfoliosto the individual student portfoliosMemorial ?Memorial ?

9b. Evaluation forms9b. Evaluation forms

Northern OntarioNorthern Ontario: PBL evaluation q 6 weeks+ MCQ on : PBL evaluation q 6 weeks+ MCQ on professionalism, pending for clerkshipprofessionalism, pending for clerkship

OttawaOttawa: available for pre-clerkship, under review for clerkship: available for pre-clerkship, under review for clerkshipQueen’s: Queen’s: availableavailableSaskatchewan: Saskatchewan: available, incorporated into clerkship evaluationsavailable, incorporated into clerkship evaluationsSherbrookeSherbrooke: available: availableToronto: Toronto: availableavailableUBCUBC: professional behavior assessed, both summative and : professional behavior assessed, both summative and

formative formative University of Montreal: University of Montreal: preclerkship form being revisedpreclerkship form being revisedWestern:Western: none none

10. Is passing professionalism component 10. Is passing professionalism component mandatory in pre-clerkship?mandatory in pre-clerkship?YESYESCalgary Calgary DalhousieDalhousieMcGillMcGillMcMasterMcMasterMemorialMemorialNorthern OntarioNorthern OntarioOttawaOttawaQueen’sQueen’sSaskatchewanSaskatchewanSherbrookeSherbrookeToronto Toronto UBC (all programs have a UBC (all programs have a

remediation program)remediation program)University of MontrealUniversity of MontrealWesternWestern

NONOAlbertaAlbertaLavalLavalManitobaManitoba

11. Is passing the professionalism 11. Is passing the professionalism component mandatory in clerkship?component mandatory in clerkship?

YESYESAlberta Alberta CalgaryCalgaryDalhousieDalhousieMcGillMcGillMcMasterMcMasterNorthern OntarioNorthern OntarioOttawaOttawaQueen’sQueen’sSaskatchewanSaskatchewanSherbrookeSherbrookeTorontoTorontoUBC (all programs have a UBC (all programs have a

remediation program)remediation program)University of MontrealUniversity of Montreal

NONOLavalLavalManitobaManitobaMemorialMemorial

12. Can a student be dismissed on basis of 12. Can a student be dismissed on basis of failing the professionalism component?failing the professionalism component?

Most said YESMost said YES No: Laval and ManitobaNo: Laval and Manitoba

13. Is professionalism assessed as part of 13. Is professionalism assessed as part of admission process?admission process?

CalgaryCalgary-MMI-MMIMcMasterMcMaster-specific stations -specific stations

MMI MMI Northern Ontario-Northern Ontario-via multi via multi

station interviewstation interviewSherbrookeSherbrooke-use TAAMUS -use TAAMUS

testtestUBCUBC-review -review

portfolio/interviewportfolio/interview

NONOAlbertaAlbertaDalhousieDalhousieLaval (considering MMI)Laval (considering MMI)ManitobaManitobaMcGillMcGill?Memorial?MemorialOttawaOttawaQueen’sQueen’sSaskatchewanSaskatchewanTorontoTorontoUniversity of MontrealUniversity of Montreal?Western?Western

14a. Organization14a. Organization

Alberta: Alberta: Joint professionalism in the workplace and learning Joint professionalism in the workplace and learning environment committee in the regionenvironment committee in the region

CalgaryCalgary: Professionalism ad hoc committee,: Professionalism ad hoc committee,Dalhousie: Dalhousie: New New Faculty of Medicine Professionalism committeeFaculty of Medicine Professionalism committeeLaval: Laval: Professionalism committeeProfessionalism committeeManitobaManitoba: Director of Humanities – Professionalism, Ethics and : Director of Humanities – Professionalism, Ethics and

HumanitiesHumanitiesMcGillMcGill: Office of Curriculum Development and Physicianship : Office of Curriculum Development and Physicianship

Coordinating CommitteeCoordinating CommitteeMcMaster:McMaster:Professional Competency (ProComp) curriculum co Professional Competency (ProComp) curriculum co

chairs ( & domain planners group)chairs ( & domain planners group)MemorialMemorial: Curriculum coordinator for Humanities, Ethics and : Curriculum coordinator for Humanities, Ethics and

LawLawNorthern OntarioNorthern Ontario: under Phase I chair: under Phase I chair

14b. Organization14b. Organization

OttawaOttawa: Single chair of professionalism, committee being formed: Single chair of professionalism, committee being formedQueen’s: Queen’s: Working group on professionalismWorking group on professionalismSaskatchewan: Saskatchewan: Clinical skills and professionalism sub-committeeClinical skills and professionalism sub-committee SherbrookeSherbrooke: Professionalism MD committee: Professionalism MD committeeToronto: Toronto: One person responsible for ethics and professionalism One person responsible for ethics and professionalism

themethemeUniversity of Montreal: University of Montreal: Ethics committee responsible for Ethics committee responsible for

preclerkship and clerkshippreclerkship and clerkshipWesternWestern: Leader Dr. J. Nisker has an assistant: Leader Dr. J. Nisker has an assistantUBCUBC: Theme Directors for Professionalism & Ethics + Ad Hoc : Theme Directors for Professionalism & Ethics + Ad Hoc

advisory committeeadvisory committee

SummarySummary

Most sites have a code/declaration and a Most sites have a code/declaration and a ceremony ceremony

Most sites have some professionalism teaching Most sites have some professionalism teaching in the pre-clerkship curriculumin the pre-clerkship curriculum

Some are starting to develop a clerkship Some are starting to develop a clerkship curriculumcurriculum

Professionalism competency is a requirement Professionalism competency is a requirement for passing pre-clerkship and clerkship at most for passing pre-clerkship and clerkship at most sitessites

Recommendations for a Recommendations for a professionalism programprofessionalism program

Faculty:Faculty: need an official calendar with expectations of all members of staffneed an official calendar with expectations of all members of staff

Teaching faculty:Teaching faculty: aware of behavioural standards as role models aware of behavioural standards as role models measures for evaluationmeasures for evaluation

Students:Students: welcome to profession with an oath ceremonywelcome to profession with an oath ceremony educational activities, through preclerkship and clerkshipeducational activities, through preclerkship and clerkship EvaluationEvaluation

Organization:Organization: Office of professionalismOffice of professionalism Integration with teaching of Ethics and HumanitiesIntegration with teaching of Ethics and Humanities Faculty developmentFaculty development

Points for discussionPoints for discussion

What do you see as some of the major barriers?What do you see as some of the major barriers? What works best?What works best?

Future directionsFuture directions Unclear what is the faculty development at each siteUnclear what is the faculty development at each site What about the resident teaching?What about the resident teaching? More student involvementMore student involvement Processes when problems arise are requiredProcesses when problems arise are required Websites and teaching/evaluation materials are Websites and teaching/evaluation materials are

developing and some are already availabledeveloping and some are already available Complete list of all national program contactsComplete list of all national program contacts List of oaths/resources on the AFMC websiteList of oaths/resources on the AFMC website Resources:Resources:  http://http://www.afmc.ca/pages/sa_professionalism.htmlwww.afmc.ca/pages/sa_professionalism.html

Thank you for Thank you for participating!!!participating!!!