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Students, residents and educators putting new emphasis on professionalism

Copyright © 2003 by the American College of Physicians.

By Phyllis Maguire

While physicians struggle to balance professionalism with the pressures of real-world medical practice, a movement is growing to make the issue of professionalism much more visible in teaching and training programs.

That stronger emphasis on professionalism is good news, educators say. "I think a 'professionalism movement' is now going on in both medical schools and the profession," said Adina L. Kalet, FACP, assistant professor of clinical medicine at the New York University (NYU) School of Medicine in New York. "Focusing on professionalism gives us a positive way to integrate a whole series of difficult topics, such as altruism, communication skills and health care economics."

The ABIM Foundation, which helped draft a charter on medical professionalism as part of the Medical Professionalism Project, is encouraging educators to boost their focus on professionalism even further. As part of that effort, the foundation established a new "Putting the Professionalism Charter into Practice" initiative last year. It also recently gave $10,000 seed grants to five medical schools in the United States and Canada, including NYU; McGill University in Montreal; University of California, San Francisco School of Medicine; University of Michigan Medical School in Ann Arbor; and the University of Texas Medical Branch in Galveston.

Some awardees plan to incorporate the charter into their curriculum, saying it provides a framework to help them discuss and evaluate professionalism. Others have modified the charter language to make it applicable to other members of the academic and medical team. All said they have found it to be a useful tool.

"The charter is an important first step," said Dr. Kalet. "But we've got to get much more specific about what professionalism means in order to teach and evaluate students."

Professionalism in the curriculum

Educators at NYU plan to use some of their grant to host an international conference on professionalism issues. They will also use some money to help medical students develop their own professionalism curriculum.

And NYU faculty are using part of the grant to hold workshops that enhance students' self- and peer-assessment skills. The workshops present vignettes of typical unprofessional behavior in training programs, such as being rude, making patients wait and not filling out charts in a timely manner, Dr. Kalet said. Students then use role-playing to explore ways to give colleagues constructive feedback about those behaviors.

"We're preparing students to participate in a meaningful assessment of professionalism, not only in themselves but also in colleagues," Dr. Kalet said.

At the University of California, San Francisco School of Medicine, Maxine A. Papadakis, MD, professor and associate dean of student affairs, said faculty are now devising a system to evaluate professionalism not only in students, but also in residents and faculty. She said she hopes those efforts lead to a more respectful teaching environment that extends to all members of the health care team, including nurses and social workers.

At the University of Michigan, David T. Stern, ACP Member, associate professor of internal medicine and medical education, said the school plans to use the grant to improve methods of teaching professionalism. Professionalism will be a major component of a new medical school curriculum the university will implement this August. And educators are exploring ways to teach faculty how to focus on professionalism issues and expectations during teaching and training.

"The faculty are students' role models," Dr. Stern said, "but often that role modeling isn't active." If he washes his hands in a patient's room without explaining his reasons for doing so, for instance, medical students might assume he's just trying to ward off disease.

"Instead, I need to explain that washing my hands also expresses respect for the patient, which is a professionalism issue," he said. "Without that kind of active discussion, we miss a lot of positive opportunities to teach professional standards and behavior."

Expanding professionalism

Other schools are expanding the discussion on professionalism beyond their individual institutions. At Montreal's McGill University, for instance, Richard L. Cruess, MD, a former dean of medicine, has passed the professionalism charter to the 16 other Canadian medical schools. Representatives from all the schools will meet in May to discuss collaborating on a joint professionalism initiative.

And at the University of Texas Medical Branch in Galveston, Alice Anne O'Donell, MD, director of the predoctoral program in family medicine, said the grant helped support the school's decision to redraft the charter, making it relevant to all members of the health care team, not just physicians.

"Originally, our idea was to have it apply only to other professionals," such as the faculty of the biomedical sciences, nursing and allied health schools, Dr. O'Donell said. "But we decided to make the charter even more generic to include staff members as well—and to enhance the sense of professionalism throughout the entire campus."

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