Development of Professionalism and Fitness to Practice

1
Development of Professionalism and Fitness to
Practice

• Trudie Roberts
• Kathy Boursicot

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Workshop format

• Setting the scene Professionalism in the 21st
  century
• Defining professionalism
• How to teach professionalism?
• How to assess professionalism and ensure fitness
  to practice?
• Summary

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Professionalism in the 21st Century
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The Past

• The past is that part of eternity with some
  small fraction of which we have a slight and
  regrettable acquaintance
• A. Bierce from The Devils Dictionary

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The past a golden age

• Patients were passive and grateful
• Regulation of doctors was controlled by doctors
  themselves
• Public accountability was negligible
• Social prestige was high

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The Present

• A place of multiple realities
• D.J. Cottrell 2000

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(No Transcript)
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The Present

• A time of unprecedented change
• No return to the golden age
• A questioning society
• Professions including medicine have lost status
• Professionalism is the key to public trust
• The future will depend in part on how medicine
  responds

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Present Challenges

• The changing healthcare system
• Issues of professional competence
• Quality assurance

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The Changing Healthcare System

• The changing focus of patient treatment
• The changing focus of illness
• The changes in society
• The change in public expectations

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Changing value systems

• Libertarian

Communitarian
Utilitarian
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The Changing Composition of Societies

• Population movement
• Globalisation and migration
• Development of cultural diversity within
  geographical regions

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The Change in Public Expectations

• Consumer society
• Empowerment
• Choice
• Informed public
• Increased access to information
• media

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Competing models

• Professionalism
• Consumerism
• Regulation
• Management
• Accountability

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Changing world of work

• Unique point in time 4 distinct groups of
  workers
• Duxbury 2002

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Types

• Traditionalists
• Baby boomers
• Generation X
• Generation Y

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Pre 1946 Traditionalists

• Totally committed to the company
• Horrified by unemployment
• Would go down with the ship
• Typified by unquestioning loyalty

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1947- 1972 Baby Boomers

• Workaholics
• Accept stress as part of the job
• Used to belt tightening and sacrifice
• Work predicated on delayed gratification
• Value titles and status symbols

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1968 1980 Generation X

• Place more importance on career than personal
  life
• Mistrustful and suspicious of employers
• Products of downsizing and cost cutting
• Usually had experience of many jobs
• Not committed to a particular company
• Want immediate gratification

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1980 1995 Generation Y

• Want a balance of work and personal life
• Take time off for personal life enhancement
• Demand flexible environments and benefits
• Do not expect a job for life
• Expanding job market and shrinking work force
• Expect and get immediate reward

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• How do each of these groups interpret
  professionalism?

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Can professionalism survive?
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(No Transcript)
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The Future

• The future is that period of time in which our
  affairs prosper, our friends are true, and our
  happiness is assured
• A. Bierce from The Devils Dictionary

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• The Social Contract hinges on professionalism. To
  preserve medicines values in changing times, it
  is essential for physicians to understand
  professionalism and the obligations required to
  sustain it.

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Workshop format

• Setting the scene Professionalism in the 21st
  century
• Defining professionalism
• How to teach professionalism
• How to assess professionalism and ensure fitness
  to practice
• Summary

27
(No Transcript)
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Definitions (1)

• UKs GMC
• Duties of a Doctor
• Good Medical Practice
• CanMEDS
• Medical expert, communicator, collaborator,
  manager, health advocate, scholar, professional
• ABIM/ACP/EFIM A Physician Charter
• Patient welfare
• Patient autonomy
• Social justice

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Definitions (2)

• Swick
• Need for a definition
• 9 professional behaviours
• Cruess Cruess
• Physician as Healer / as Professional
• Damaged social contract
• Cosgrove
• Professionalism state not trait

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Definitions (3)

• Calman The Profession of Medicine
• High ethical standards
• CPD, change and improvement, RD
• Teamwork
• Health as well as illness
• Concern with clinical effectiveness outcomes
• Ability to communicate

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What do we mean by Professionalism?

• Six Domains
• Ethical practice
• Reflection / self awareness
• Responsibility for actions
• Respect for patients
• Working with others
• Social responsibility

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Workshop format

• Setting the scene Professionalism in the 21st
  centuary
• Defining professionalism
• How to teach professionalism?
• How to assess professionalism and ensure fitness
  to practice?
• Summary

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(No Transcript)
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NEW MEDICAL STUDENT
MATURE PROF- ESSIONAL
PERIOD OF PROTO-PROFESSIONALISM
MATURITY
PHRONESIS
EXPERIENCE
SDL
NAIVE
PBL
ve ROLE MODELS
Y1 Y2 Y3 Y4 Y5 Q
Reg ? PGT



O
NAÏVE

N
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NEW MEDICAL STUDENT
MATURE PROF- ESSIONAL
PERIOD OF PROTO-PROFESSIONALISM
IDEALISTIC
BAD EXPERIENCES
-ve ROLE MODELS
CYNICAL
FATIGUE
POLITICS
ADDICTIVE BEHAVIOURS
Y1 Y2 Y3 Y4 Y5 Q
Reg ? PGT



O
NAÏVE

N
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How Can Professionalism Be Taught?

• Role Models
• Didactics on History of Medicine, Self-Regulation
  and Public Policy
• Small Group Discussions
• Grand Rounds
• Named Lectures
• Teaching ward rounds
• Clinical Vignettes
• Reflective Exercises
• Self-Assessment/Narratives

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PERIOD OF PROTO-PROFESSIONALISM
NEW MEDI- CAL STUDENT
MATURE PROFESSIONAL
ACQUISITION ?
DECAY ?



O
NAÏVE

N
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Workshop format

• Setting the scene Professionalism in the 21st
  century
• Defining professionalism
• How to teach professionalism?
• How to assess professionalism and ensure fitness
  to practice?
• Summary

39
(No Transcript)
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Model of competence
Professional authenticity
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S67.
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Climbing the pyramid......
Does
Shows how
Knows how
Knows
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New skills emphasized

• learning how to learn
• self-appraisal
• leadership
• team skills
• metacognition
• professionalism
• reflectiveness/reflexiveness.

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Extending the pyramid
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How to assess meta-skills?

• Self assessment
• Peer assessment
• Co-assessment (combined self, peer, teacher
  assessment)
• Patient ratings
• Log book/diary
• Structured evaluations (mini cex etc)
• Portfolio assessment..

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How to assess meta-skills?

• Basic method Information gathering relying more
  on descriptive and qualitative judgemental
  information

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Workshop format

• Setting the scene Professionalism in the 21st
  centuary
• Defining professionalism
• How to teach professionalism
• How to assess professionalism and ensure fitness
  to practice
• Summary

47
Thank you