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Teaching Medical Professionalism

Teaching Medical Professionalism. Cherdsak Iramaneerat Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University. Medical Professionalism.

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Teaching Medical Professionalism

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  1. Teaching Medical Professionalism Cherdsak Iramaneerat Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University

  2. Medical Professionalism • the mastery of a complex body of knowledge, with an ethical commitment to integrity, morality and altruism. These skills and attitudes are used in the service of others as the basis of a social contract between the medical profession and the community. Society, in return, grants the privilege of self-regulation and autonomy in practice Ethics Committee of the New Zealand Medical Association

  3. Medical Professionalism • Key components: 6 domains • 3 Intrinsic attributes • Ethical practice • Reflection and self-awareness • Responsibility and accountability • 3 extrinsic (cooperative) attributes • Respect for patients • Teamwork • Social responsibility Hilton SR, Slotnick HB. Proto-professionalism: how professionalisation occurs across the continuum of medical education, Medical Education (2005) 39: 58-65

  4. Some Challenges in Teaching Medical Professionalism • No clear concepts: not clear about what to teach • Students can learn by observation: These things do not need to be said • These things are fixed trait. It is too late to change their values and characters now. • This is not my job. It is somebody’s job • I am not good enough • I don’t know how to teach

  5. Clear Concepts • ABIM, ACP-ASIM, EFIM. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine 2002: 136; 243 – 6. • Fundamental principles of medical professionalism • Principle of primacy of patient welfare • Principle of patient autonomy • Principle of social justice

  6. Clear Concepts • Goldie J. Review of ethics curricula in undergraduate medical education. Medical Education 2000; 34: 108 – 19. • De Camp conference recommendation on medical ethics core curriculum • Ability to identify the moral aspects of medical practice • Ability to obtain a valid consent or refusal of treatment • Knowledge of how to proceed if a patient is incompetent, refuses treatment • Ability to decide when to withhold information, breach confidentiality • Moral aspects of caring for poor prognosis patients

  7. Needs for Teaching? • Eckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching “Generation Y”. Journal of Graduate Medical Education, 2011: 458 – 61. • Generation Y (Millennial generation): individuals born between 1982 – 2005. • Uncertainty: terrorism, globalization, economic recession, SARS outbreak • Values: online connectedness, teamwork, free expression, work-life flexibility, technology • Teaching: require clear instructions in everything, observable behaviors, explicit communication • No assumption of common knowledge

  8. Fixed Traits? • Gladwell M. The tipping point: How little things can make a big difference. Little Brown publishing 2000. • Tipping point = the point where things change, ie., the threshold, the boiling point • Three rules of epidemics • The law of the few • The stickiness factor • The power of context

  9. Fixed Traits? • Self DJ Baldwin DC, Jr. Does medical education inhibit the development of moral reasoning in medical students? A cross-sectional study. Academic Medicine 1998; 73: S91-3. • Patenaude J, Niyonsenga T, Fafard D. Changes in the components of moral reasoning during students’ medical education: A pilot study. Medical Education 2003; 37: 822 – 9. • The usual age-appropriate increase in medical students’ moral reasoning scores did not occur, suggesting that the experience of medical training inhibited moral development rather than facilitated it.

  10. I’m not Good Enough! • Stern DT, Papadakis M. The developing physician – Becoming a professional. N Eng J Med 2006; 355: 1794 -9. • A role model is “someone who, in the performance of a role, is taken as a model by others.” Role modeling is in the eye of the beholder — the student, not the teacher. “Individuals who are seen as mentors may not realize that they are teaching professional values, and those not seen as mentors may believe that they are.”

  11. Teaching Medical Professionalism • Formal curriculum • Ethics courses • Ethics case discussion • Ethical conference • Ethical round • Hidden curriculum • Environment: moral culture of norms and values • Parables • Role models

  12. Questions & Comments Cherdsak.ira@mahidol.ac.th Instructional techniques

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