Professionalism

The overall sense I got from the feedback from all of you set me off on a quest to looking for what the medical education world thinks of professionalism I found the following:

Merriam-Webster's Collegiate Dictionary defines professionalism as “the conduct, aims and qualities that characterize or mark a profession or a professional person.” This would serve as a denotation the connotations associated with this definition is well captured by present day leaders in the field of medical professionalism Drs. Richard and Sylvia Cruess of McGill University. They describe the overlap of the healer and professional in the role of beings physician.

 Direct quote: The following diagram highlights this crucial balance: 

http://www.afmc.ca/pages/professionalism/1CruessSlides.ppt Accessed July 2007. 

So, if I may, use the above denotations and connotations and look for the belief and the meta-belief. The belief in reference to the above mentioned information is physicians have to have the attributes of being both a healer and a professional and the meta belief is that the attributes listed are compatible and define the belief.

Professionalism is a well- practiced and learned behavior which is associated with the profession. If I were to define professionalism it would include the belief that physicians are in the profession of gaining patients trust and confidence but has to measure and modulate a treatment plan without (as far as possible) the personal biases and cognitive fallacies. Meaning it has to be based on honest, code of ethics that respects the choices of the patient but offers all the rationale (without personal bias). In the process the physician should have the responsibility to base his views on evidence based practice. Patients evoke a lot of emotions and very often surface the bias associated with the stereotyping of individuals. The professional approach would be the fundamental approach of altruistic, honest, respectful and confidentiality of the patient is of prime importance. At the end of an interaction with a patient was the patient able to trust you with their issue and know that you would do the best for them. The physicians are held at a high accountability to the immediate society of practitioners and society at large. Professional behavior is to make sure that the patient have understood their medical concern first and then the recommendation and the reasons for the recommendation so that they can make an informed decision for their own healing process. In order to enable this type of healing the best approach in my opinion would be patient-centered and intraprofessional.

To apply what we learned in last class: what am I basing these values on? Are they collective memories of best experiences in patient-doctor interactions? Interpretation of what we perceive as the accepted norms in society. To answer this quarry; I went back to articles on professionalism and came across Kirk's interpretation of professionalism and how and where it can be taught.  

Here is a direct quote from the cited article "Competency in professionalism, however, tends to involve noncognitive skills, including communication (language, empathy, integrity, compassion), collaboration (responsibility, respect, duty), and continuous improvement (recognition of limitations, motivation to improve)2". In the same article she goes not to say that assessing professionalism calls for both formative and summative feedback that details the kind of behavior that is appreciated and the behaviours that are not appreciated or unacceptable in some cases.

I went back to the reflection written by the students on their first module in medical school and tried to tease out where they recognized professionalism and how they interpreted it. A number of students were touched by the stories on how doctors were patients and what they saw from the flip side of the equation. Most were shocked that not many were unhappy with the behaviours of the doctors who handled their cases. A few students reflected on how they were instructed on a dress code associated with the profession. A few pondered on whether it was even necessary. Most however reflected on how medical ethics play a role in decision making and why it was important for them to be familiar with that aspect of medical education. A few students listed communication and collaboration as skills that they had not previously thought to be important but after a month of discussion based learning realised the importance of it. The other key concepts they brought forward are desensitising themselves to be a healer who does not get too caught up in the emotions associated with their patients. Some were shocked at how unnerving it was to ask the standardized patient very personal details; details they were uncomfortable with themselves.

One month into medical school and they have recognized salient features associated with the profession. I think that a whole lot of learning is taking place and the hidden curriculum is being found out in very varied learning experiences but nevertheless recognized. I believe that is evidence that the metabeliefs linked with the beliefs and the varied methods of teaching and learning are collectively 'doing the job' and received well by the students. The whole curriculum is in the process of restructuring. The series of talks from practising physicians was one of the improvisations offered this year and was highlighted as the most powerful learning experiences by most of the students. I must say it is encouraging to see we are moving n the right direction. Is it measurable ....?

In the next posts I would like to reflect on ethics in that practice of medical education.

1. http://www.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html

2.Lynne M. Kirk; Professionalism in medicine: definitions and considerations for teaching;

Proc (Bayl Univ Med Cent) 2007 January; 20(1): 13–16.PMCID: PMC1769526