The
previous comments from my peers sent me on a search on measurements of professionalism,
internalization of professionalism and whether professionalism is a cognitive
or behavioural skill.
Internalization
of professionalism is what I believe is the affective nature of the assessment
component. I was looking the most popular mode of assessment for various levels
of medical education (at the undergraduate and post graduate levels). There are
several assessment modes including both formative and summative assessments. MCQs
exams are one of the popular modes of assessment. Can MCQs be used to assess
the affective domain? I would say yes, if the question is well structured and
the distractors are well thought out. But does point to the internalization of
the attributes? I would think not. Where and how can we even see an
internalized behaviour playing out in front of the patient or peers? Peer
reviews may be a better measure; as well as, repeated formative feedback during
clerkship could illicit an actual observation of internalized professionalism. I do not think any of the existing methods fully assess affective domains but could be a combination of various assessment tools including self reflection. I came across an article which described residents have a self reflective paper presentation on the "patient of the week". Where they discuss why it stood out and what diffuculties they came across as professionals.
As I was researching
for a methodology of some kind I came across transformative learning and Jungian
psychology4. “A learning in which we become
fully aware of who you are, we are more fully able to enter into the community
of humans. This is transformative learning, the emergence of self.” TPST is
coxing us to do the same. When we are attempting to teach values that can be integrated
in to the students’ inner being we are expecting transformative learning to
occur. The more I read about it the more I would like to apply it. As the
description implies it does push you to you uncomfortable zone, question the
taken-for granted facts and figure out if the concepts or facts are warranted.
I feel like that is what the exercise last class was pushing us to do. I would
like to take the time to develop this skill and evaluate the claims in a more
skeptical manner. Definitely a skill I need to work on.
Back to
my question, the direction I would like to pursue is the following:
Professionalism
and ethics:
Aspects
of professionalism and ethics I would like to explore here are the following:
Nurturing
and educating budding physician on the various competencies have a direct
impact on the society they serve. My stand here today is that these
competencies prepare the students to believe in their learned judgement calls. It
also prepares them on the actions to be taken if a professional error has
occurred. This confidence in being aware of how to handle the non-expert
aspects of medical care renders a more positive work environment1.
Clinical ethics
tie in with professionalism and health advocate. “Competence in clinical ethics
depends not only on being able to use a sound method for analysis, but also on
familiarity with the literature of medical ethics2.”
Paradigm
as published on University of Washington School of Medicine website: http://depts.washington.edu/bioethx/tools/4boxes.html
|
I have
not come close to completion for this post but only got to the point to even a
concept map of where I am heading. I need to research further.
1. Positive Role of Professionalism
and Ethics Training in Medical Education: A Comparison of Medical Student and
Resident Perspectives; Laura Weiss
Roberts, M.D.; Katherine A. Green Hammond, Ph.D.; Cynthia M.A. Geppert, M.D.,
Ph.D.; Teddy D. Warner, Ph.D.; Academic Psychiatry 2004;28:170-182. 10.1176/appi.ap.28.3.170.
2.
Albert R. Jonsen, Mark Siegler, and William
J. Winslade, Clinical Ethics: A Practical Approach to Ethical Decisions in
Clinical Medicine, 4th edition. New York: McGraw-Hill, Inc., 1998.
3. Krupat, Edward PhD; Dienstag,
Jules L. MD Commentary: Assessment Is an Educational Tool; Academic Medicine: May
2009 - Volume 84 - Issue 5 - pp 548-550; doi: 0.1097/ACM.0b013e31819f7fb9
4. http://www.scribd.com/doc/26451894/Transformative-Learning-in-Practice-Insights-from-Community-Workplace-and-Higher-Education
Hi Anna,
ReplyDeleteI was struck by your discovery and how similar it was for my blog this week. "Transformative learning to occur. The more I read about it the more I would like to apply it. As the description implies it does push you to you uncomfortable zone, question the taken-for granted facts and figure out if the concepts or facts are warranted". I wonder what Jung and Mezirow had in common that they speak a similar but slightly different language, each getting at a transformation as a result of learning for students. Self reflection from Jung sounds like a similar activity included in perception transformation with reflective activities.
I suspect your next topic, professionalism and ethics may tie into this.
Beth
Hi Anna,
ReplyDeleteMy immediate reaction when you brought up MCQs was "NO - NEVER!", though I suppose it could yield some information. Then when you questioned whether behavioral observation could provide insight into internalized of professionalism I thought you were too quick to dismiss this idea. First, I think that we can infer information from the behavior of others. For instance, a student who comes in, unshaven, shirt half tucked in, alcohol on their breathe and who then speaks in a short, dismissive tone to his or her (though they shaven part wouldn't apply in this case) patients may give you some idea to the extent to which they internalize professionalism. Second, you can always have the student explain why they are doing something as they do it. I do this sometimes when I teach some research methods. For instance, I produce a behavior and then call attention to students of the behavior and why I used it (e.g., during interview and focus group training). Perhaps these ideas could help as you consider assessment of the affective component of professionalism.
One final very small point/observation - when you mention the next step of your exploration "Nurturing and educating budding physician on the various competencies have a direct impact on the society they serve", which 'various competencies' are you referring to?
I liked the concept map/diagram at the end and I'm interested to see how you incorporate this into your own map of competencies assessment.
Hi, Anna,
ReplyDeleteYou and I have both looked to competencies in an attempt to measure learned professionalism. I have realized we have to accept subjective measurements of this affective learning, but I have also struggled with the idea of determining whather professionalism was learned as represented by behaviours, as Jules outlined in his comment above.
You stated that "these competencies prepare the students to believe in their learned judgement calls". I agree, but determinig how to "prove" this via questions to ask when evalutaing claims has me shaking in my boots.
It is the assumptions piece (that we can actually determine knowledge has been gained, learning has occurred in the realm of professionalism), that I have not been able to support to date.
From the marking rubric, you seem to have provided a useful question that provides useful direction for the overall inquiry (question quality) and you've synthesized new information with prior information (reasoning).
I eagerly read your posts to help me gain insight into the same issue I have!
Anna, you were heading in such an interesting direction toward the end, but then I think you gave up too soon! Just when you were getting to the "meat" of it, it was over. :)
ReplyDeleteI wondered about the connection between what you say in this post regarding clinical ethics and the distinctions you drew in earlier posts between expertise and competency. There seems to be a contradiction.
For instance, here you say: "Clinical ethics tie in with professionalism and health advocate. “Competence in clinical ethics depends not only on being able to use a sound method for analysis, but also on familiarity with the literature of medical ethics2.”
But that seems to be expertise, not competence -- based not only on how these terms are commonly used, but on your own posts a few weeks back.
I was, I admit, a little disappointed to find that you did not engage with the challenge to assess one of your own claims anywhere in here. I know you can! Hopefully we see you doing some of that soon.