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Teaching and Evaluating Physicianship

Teaching and Evaluating Physicianship. The Healer The Professional. Work in Progress. What we have accomplished Our hopes for the future. What is Physicianship?. The Physician Has Two Roles. Healer Professional. The two roles. Served simultaneously. Analyzed separately.

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Teaching and Evaluating Physicianship

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  1. Teaching and Evaluating Physicianship The Healer The Professional

  2. Work in Progress • What we have accomplished • Our hopes for the future

  3. What is Physicianship?

  4. The Physician Has Two Roles • Healer • Professional

  5. The two roles • Served simultaneously. • Analyzed separately.

  6. Professionalism and Medicine The concept of the healer The concept of the professional Middle ages “Learned professions” clergy, law, medicine 1850: Legislation 1900: University linkage The Present Antiquity Hippocrates technology “curing” The Present Code of Ethics Science

  7. Medicine’s Values Are Derived From Both The Healer and the Professional

  8. The Primary Role is that of the Healer

  9. Society uses the concept of the professional as a means of organizing the delivery of complex services which it requires, including that of the healer. “The Professional Model”

  10. Other Models are Available > • Bureaucratic • Free Market Neither Share the Values of the Healer none pure

  11. Medicine fulfill the role of the healer guaranteed competence altruistic service morality and integrity promotion of the public good openness accountability Society monopoly autonomy trust and respect self-regulation adequate resources status and rewards financial non-financial The Social Contract TRUST

  12. The social contract in health care hinges on professionalism. • It serves as the basis for the expectations of both medicine and society.

  13. To preserve values in changing times, Physicians must understand the linked roles of the healer and the professional. • They must be taught.

  14. To Heal To make whole or sound in bodily conditions; to free from disease or ailment, to restore to health or soundness. Oxford English Dictionary

  15. DefinitionProfession “An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.” Derived from the Oxford English Dictionary and the Literature on Professionalism In Press, “Teaching and Learning in Medicine”

  16. Attributes Caring and compassion Insight Openness Respect for the healing function Respect patient dignity and autonomy Presence Autonomy Self-regulation Responsibility to society Team work Competence Commitment Confidentiality Altruism Integrity and honesty Morality and ethics Responsibility to the profession Professional Healer

  17. Each attribute will be reflected (or not) by appropriate (or inappropriate) behavior. • These behaviors can be observed and evaluated.

  18. The Challenge • How to impart knowledge of Physicianship to students and residents. • How to encourage behavior characteristic of the good physician.

  19. By concentrating on the role of the Professional we risk neglecting that of the Healer - in spite of overlap THEY ARE DIFFERENT

  20. General Principles • Integrated approach throughout faculty for undergraduate and postgraduate education. • Support of Dean’s Office and Chairs. • Multiple techniques of teaching. • The International Charter • formal teaching • small groups • independent activities • role models - attendings - residents • other

  21. General Principles • Evaluate what is taught. The International Charter • Faculty and Resident development essential.

  22. Faculty Development 1) Teaching Professionalism - think tank (20) 2) Teaching Professionalism: Dean’s Invitation (40) 3) Evaluating Professionalism - think tank (20) 4) Evaluating Physicianship - (90) Behaviors Identified 150 Faculty members and residents have participated. Large pool of trained teachers and role models.

  23. McGill: 1996 - 2003 • Body Donor Service: 1992 • Prof 101 followed by small groups: 1997 • Elective: The Profession and Society: 1999 • White Coat Ceremony: 2000 • Mandatory half day on professionalism 2000 for all residents (CanMeds) • Professionalism 101 to incoming students 2003 201 to 1st year students 2004 20 students Pledge

  24. Assessment: teaching • episodic • ineffective evaluation • methods primitive • ineffective the role of the healer not addressed explicitly.

  25. Program on Physicianship • to teach the role of the Healer and The Professional. • to promote behaviors characteristic of both. • to evaluate knowledge of both roles • to evaluate behaviors characteristic of both.

  26. Four Committees The Healer The Professional Evaluation Post Graduate Education

  27. Recommendations Undergraduate • A longitudinal program on physicianship throughout 4 years of medical school. • Distinct approaches to the Healer and the Professional. • Incorporate existing activities including ethics. • Create new learning experiences. • Revise evaluation system - global rating scale - miniCEX • All students must successfully complete program.

  28. Recommendations Postgraduate • All residents must master the cognitive base of professionalism. • Self reflection must be promoted - small groups - ? portfolios • revise evaluation system - global rating scale - miniCEX

  29. Content • Whole class (Flagship) activities at regular intervals • Lectures small groups • ethics small groups • introduction to the cadaver small groups • body donor service • white coat ceremony • 4th year seminars

  30. Content • unit specific activities (small group) pre-clinical clinical • humanism/narrative medicine • spirituality • palliative care medicine • community service • portfolio (self-reflection, self-assessment)

  31. Evaluation • longitudinal - 4 years • multiple methods • knowledge - mcq etc. - (do often) • global rating scale - UCSF, Maastrict • critical incidents • portfolio • ? MiniCEX ALL ATTRIBUTES MUST BE EVALUATED USING AT LEAST ONE METHOD

  32. Faculty Development • essential - includes residents • knowledge role modeling • evaluation Requires resources

  33. Resources Assoc/Assist Dean for Physicianship Infrastructure Support - financial and other

  34. Summary • The role of the Healer and the Professional must be taught. • Must start with agreed-upon definitions. • The teaching of physicianship should represent a major commitment of the faculty. • It should be taught and evaluated in a planned way throughout the curriculum.

  35. “The most important problem for the future of professionalism is neither economic nor structural but cultural and ideological. The most important problem is its soul” Freidson, 2001

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