Development of Professionalism and Fitness

to PracticeTrudie Roberts

Kathy Boursicot

Workshop format

•Setting the scene – Professionalism in the 21st century

•Defining professionalism

•How to teach professionalism?

•How to assess professionalism and ensure fitness to practice?

•Summary

Professionalism in the 21st Century

The Past

“The past is that part of eternity with some small fraction of which we have a slight and regrettable acquaintance”

A. Bierce from The Devil’s Dictionary

The past – ‘a golden age’

•Patients were passive and grateful

•Regulation of doctors was controlled by doctors themselves

•Public accountability was negligible

•Social prestige was high

The Present

“A place of multiple realities”D.J. Cottrell 2000

The PresentThe Present

• A time of unprecedented change

• No return to the golden age

• A questioning society

• Professions including medicine have lost status

• Professionalism is the key to public trust

• The future will depend in part on howmedicine responds

Present Challenges

• The changing healthcare system• Issues of professional competence• Quality assurance

The Changing Healthcare System

•The changing focus of patient treatment

•The changing focus of illness

•The changes in society*

•The change in public expectations*

Changing value systems

Libertarian

Utilitarian Communitarian

The Changing Composition of Societies

•Population movement• Globalisation and migration• Development of cultural diversity within

geographical regions

The Change in Public Expectations

•Consumer society

•Empowerment

•Choice

• Informed public• Increased access to information• media

Competing models

•Professionalism

•Consumerism

•Regulation• Management• Accountability

Changing world of work

•Unique point in time – 4 distinct groups of workers

•Duxbury 2002

Types

•Traditionalists

•Baby boomers

•Generation X

•Generation Y

Pre 1946 Traditionalists

•Totally committed to the ‘company’

•Horrified by unemployment

•Would go down with the ship

•Typified by unquestioning loyalty

1947- 1972 Baby Boomers

•Workaholics

•Accept stress as part of the job

•Used to belt tightening and sacrifice

•Work predicated on delayed gratification

•Value titles and status symbols

1968 – 1980 Generation X

•Place more importance on career than personal life

•Mistrustful and suspicious of employers•Products of downsizing and cost

cutting•Usually had experience of many jobs•Not committed to a particular company•Want immediate gratification

1980 – 1995 Generation Y

• Want a balance of work and personal life

• Take time off for personal life enhancement

• Demand flexible environments and benefits

• Do not expect a job for life

• Expanding job market and shrinking work force

• Expect and get immediate reward

How do each of these groups interpret professionalism?

Can professionalism survive?

The Future

“The future is that period of time in which our affairs prosper, our friends are true, and our happiness is assured”

A. Bierce from The Devil’s Dictionary

The Social Contract hinges on professionalism. To preserve medicine’s values in changing

times, it is essential for physicians to understand professionalism and the

obligations required to sustain it.

Workshop format

•Setting the scene – Professionalism in the 21st century

•Defining professionalism•How to teach professionalism

•How to assess professionalism and ensure fitness to practice

•Summary

Definitions (1)• UK’s GMC

• Duties of a Doctor• Good Medical Practice

• CanMEDS• Medical expert, communicator,

collaborator, manager, health advocate, scholar, professional

• ABIM/ACP/EFIM – “A Physician Charter”• Patient welfare• Patient autonomy• Social justice

Definitions (2)

•Swick• Need for a definition• 9 professional behaviours

•Cruess & Cruess• Physician as Healer / as Professional• Damaged social contract

•Cosgrove• Professionalism – state not trait

Definitions (3)

•Calman “The Profession of Medicine”• High ethical standards• CPD, change and improvement, R&D• Teamwork• Health as well as illness• Concern with clinical effectiveness &

outcomes• Ability to communicate

What do we mean by Professionalism?

Six Domains:

• Ethical practice

• Reflection / self awareness

• Responsibility for actions

• Respect for patients

• Working with others

• Social responsibility

Workshop format

•Setting the scene – Professionalism in the 21st centuary

•Defining professionalism

•How to teach professionalism?

•How to assess professionalism and ensure fitness to practice?

•Summary

NEW MEDICAL STUDENT

MATURE PROF-

ESSIONAL

PERIOD OF PROTO-PROFESSIONALISM

O NAÏVE N

NAIVE

PHRONESIS

Y1 Y2 Y3 Y4 Y5 Q Reg PGT

PBL

SDLEXPERIENCE

MATURITY

+ve ROLEMODELS

NEW MEDICAL STUDENT

MATURE PROF-

ESSIONAL

PERIOD OF PROTO-PROFESSIONALISM

O NAÏVE N

CYNICAL

IDEALISTIC

Y1 Y2 Y3 Y4 Y5 Q Reg PGT

BAD EXPERIENCES

ADDICTIVE BEHAVIOURS

-ve ROLE MODELS

POLITICS

FATIGUE

How Can Professionalism Be Taught?

• Role Models • Didactics on History of Medicine, Self-

Regulation and Public Policy• Small Group Discussions• Grand Rounds• Named Lectures• Teaching ward rounds • Clinical Vignettes• Reflective Exercises• Self-Assessment/Narratives

NEW MEDI- CAL STUDENT

MATUREPROFESSIONAL

PERIOD OF PROTO-PROFESSIONALISM

O NAÏVE N

DECAY

ACQUISITION

Workshop format

•Setting the scene – Professionalism in the 21st century

•Defining professionalism

•How to teach professionalism?

•How to assess professionalism and ensure fitness to practice?

•Summary

Knows

Knows how

Shows how

Behaviour~ skills/attitudes

Cognition~ knowledge

Model of competence

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

Does

Pro

fess

ion

al

auth

enti

city

Climbing the pyramid......

Knows

Shows how

Knows how

Does

Knows Factual tests: MCQ, essay type, oral…..

Knows how (Clinical) Context based tests:EMQ, essay type, oral…..

Shows how Performance assessment in vitro:OSCE, SP-based test…..

DoesPerformance assessment in vivo:Work based assessment, Video, Audits

New skills emphasized

• learning how to learn

•self-appraisal

• leadership

• team skills

•metacognition

•professionalism

• reflectiveness/reflexiveness…….

Extending the pyramid

Knows

Shows how

Knows how

Does

Knows

Knows how

Shows how

Does

“Meta” skills

How to assess “meta-skills”?

•Self assessment•Peer assessment•Co-assessment (combined self, peer,

teacher assessment)

•Patient ratings•Log book/diary•Structured evaluations (mini cex

etc)•Portfolio assessment……..

How to assess “meta-skills”?

Basic method: Information gathering relying more on descriptive and qualitative judgemental information

Workshop format

•Setting the scene – Professionalism in the 21st centuary

•Defining professionalism

•How to teach professionalism

•How to assess professionalism and ensure fitness to practice

•Summary