Professionalism in Medical Education

1. Professionalismin Medical Education [Insert Presenter’s Name]

2. Presentation Overview • What is professionalism? • When, where, and how are professional values learned? • What is the hidden curriculum? • Discussion of cases.

3. What Is a Professional? • One with command of a special body of knowledge and skills. • One given special privileges not generally granted to the public. • One who has special responsibilities not generally expected of the public.

4. Physicians as Professionals • Possess special knowledge and skills e.g., diagnose illness, understand treatment • Possess special privileges -e.g., ask private questions, prescribe narcotics • Have special responsibilities – e.g., put patient welfare first, regulate behavior of members of the profession

5. Professional ValuesWe Want to Teach The Charter of Medical Professionalism-a recent consensus document of internal medicine specialists-identified 3 principles of medical professionalism: • Primacy of patient welfare, • Respect for patient autonomy, • Promotion of social justice.

6. The Charter onMedical Professionalism The charter’s 3 principles are served by professional commitment to: • competence, • honesty with patients, • patient confidentiality, • appropriate relationships with patients, • improving quality of care,

7. The Charter onMedical Professionalism And professional commitment to: • improving access to care. • just distribution of finite resources, • scientific knowledge, • maintaining trust by managing conflicts of interest, • professional responsibilities.

8. Short List of Professional Attributes • Integrity • Respect for others • Accountability • Professional responsibility • Excellence • Altruism • Commitment to social justice

9. How Students LearnProfessional Values • Bring some to medical school with them. • Learn some through the formal curriculum. • Learn some from role models.

10. Attitudes Change in Training Cynicism increases during medical training: • Dislike for cancer patients. • Disdain for the emotionally ill. • Viewing alcoholics as “morally weak.” • Hostility toward suicidal patients.

11. Take-home Point • Professional behaviors change during the course of medical education--not necessarily in ways we like.

12. How Professional BehaviorIs Taught • Formal (Explicit) Curriculum • Informal (Hidden) Curriculum

13. Formal Curriculumof Values Teaching • White Coat Ceremony • Introduction to the patient, principles of medicine, ethics, etc. • Standardized patients • Evaluation

14. The Informal (Hidden) Curriculum “[The] hidden curriculum can . . . be represented by the three R’s but not . . . reading, ‘riting, and ‘rithmetic. It is . . . the curriculum of rules, regulations, and routines, of things teachers and students must learn if they are to make their way with minimum pain in the social institution called the school.” -

15. When Are Values Taught? Shift Type Call

16. Take-home Point • Professionalism is taught largely in the “hidden curriculum.”

17. Role Modeling Professional values and behaviors are taught and learned whether or not role models are intending to teach.

18. Demonstration without Explanation “The physician’s attitudes, mind-set, moral stance, and the hour-by-hour decisions about how to use one’s time—all these and many other matters, even including how and what and how much to feel, are observed by the student and imitated assiduously.“

19. Demonstration with Explanation: Reflective Practice • Student observes demonstration, • Student and teacher reflect on the demonstration, • Student demonstrates, • Teacher comments on how well the attempt matched the expectation.

20. Conflict between Values • Professionalism is rarely taught through simple expression of values, e.g., “always be honest.” • More commonly, professionalism is taught when 2 or more worthy values come into conflict, e.g., honesty conflicts with efficient patient care.

21. Case 1 • Honesty vs. Efficient Patient Care • A resident instructs a student to tell the lab that results of a routine test are needed immediately; the patient has taken a turn for the worst. This is not true.

22. Case 2 Honesty vs Professional Responsibility • A third-year student on her medicine clerkship has seen a CT scan report that suggests lung cancer. • The patient whose scan it is stops the student in the hall and asks for the test results.

23. Case 3 Professional Responsibility vs. Efficiency • A surgery resident insists that a student come with him to talk with a patient’s family about end-of-life issues. The 2 of them are gone from the floor for an hour.

24. Values in Conflict Under what circumstances might the following professional values conflict? • Respect for patient welfare and respect for classmates? for instructors?

25. Conclusions • Physicians are professionals with special privileges and corresponding responsibilities. • Professional values are most often learned in the hidden curriculum. • Students can promote development of their professionalism by asking instructors for explanations.

26. This educational presentation was prepared by: Adina Kalet, MD, MPH Asistant Professor of Medicine Division of Primary Care Department of Medicine Faculty Advisor, Professional Development Committee New York University School of Medicine ak41@nyu.edu