The Doctor as Professional Integrating professionalism into the new curriculum

1. The Doctor as ProfessionalIntegrating professionalism into the new curriculum Helen O’Sullivan and Ceri Coulby

2. Aim of this session • To develop a consensus view about what we mean by professionalism and the sorts of areas that should be included • To develop a list of values, attitudes and behaviours that we want the Liverpool Graduate to demonstrate • To come to a view about how robustly we want to assess professionalism

3. Outline plan of session • Introduction and introductions (45 minutes) • What is medical professionalism? • What does the GMC say about professionalism • How do other Schools assess professionalism ? • Workshop 1 what values, attitudes and behaviours do we want our graduates to demonstrate? (1 hour) • Workshop 2 What areas should come under professionalism ? (1 hour) • Summary, next steps (15 minutes) • Lunch

4. So what is medical professionalism? • “........signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors” Doctors in Society RCP, 2005 • From the US, David Stern has defined professionalism graphically

5. Professionalism Excellence Humanism Accountability Altruism Ethical and Legal Understanding Communication Skills Clinical Competence (Knowledge of Medicine) Arnold and Stern, 2006

6. Hilton and Slotnik (2005) • Suggest six domains in which evidence of professionalism can be expected: Personal (intrinsic) attributes: • Ethical practice • Reflection and self awareness • Responsibility/accountability for actions Co-operative attributes: • Respect for patients • Working with others • Social responsibility

7. Introduces us to phronesis and proto-professionalism

8. Jha et al 2006 Compliance to values Patient access Doctor-patient relationship Demeanour Management Personal Awareness Motivation

9. Maxine Papadakis ’ work(various co-authors and dates) • Incidents in medical school predictive of future poor performance (Board incidents) • Does not solicit feedback • Does not incorporate feedback • Critical negatives • Lack of adaptability • Arrogant, bad attitude • Always need to be right

10. O’Sullivan et al 2012 . Professionalism reflects societal values. An institutional definition must be agreed. . Situated learning in the early years is not enough. Learning must be supported in the workplace. . Role models are powerful. Both positive and negative behaviour will be seen. . Reflection on action and mentoring are important to ensure appropriate learning is achieved. . Assessment must be integrated across the course using multiple tools.

11. John McLachlan’s work • “Conscientious points” • Award students a point at every opportunity that they have to exhibit conscientiousness. • Correlates positively and strongly with measures of professionalism

12. Recent Review of Teaching Professionalism Professionalism is learned most effectively through the influence on students of clinicians they encounter in the course of their education (role models). Teaching professionalism in medical education: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25 (2013) Birden, Hudson. Medical Teacher Volume: 35 Issue: 7

13. Tools for assessing professionalism Critical incident reports Real patients ratings of students portfolios Van Mook et al 2009) Simulation Situated judgement tests On-line “values” test • Rating scales • Observation by faculty • Self assessment • Peer assessment • Multisource feedback • OSCEs and simulated patients

14. Tomorrow’s Doctors 2009 GMC Outcomes 1 – The doctor as a scholar and scientist Outcomes 2 – The doctor as a practitioner Outcomes 3 – The doctor as a professional

15. 20 The graduate will be able to behave according to ethical and legal principles. 21 Reflect, learn and teach others. 22 Learn and work effectively within a multi-professional team. 23 Protect patients and improve care.

16. How do other school assess professionalism? Peninsula Clinical and Professional Practice on of 3 blocks of assessment in each year Students undergo a number of “professionalism judgements” throughout the clinical placements Standard setting through staff development of clinical colleagues “less than satisfactory” PJ can be remediated through reflective piece 3 unremediated less than satisfactory – fail year.

17. St George’s 3 blocks of assessment – Doctor as Professional Again, multiple points of assessment throughout the year Years 1 and 2 formative – Professional Behaviour Committee Years 3 – 5 Summative – cannot programmes to next year/ graduation if fail