Teaching Professionalism: A New Curriculum

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Teaching Professionalism A New Curriculum

• Dr. Debora H. Silva
• Dr. Gladys Gonzalez-Navarrete
• UPR School of Medicine

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Background

• There are new challenges to the practice of
  medicine
• Advances in technology
• Disparities in health care
• Limited resources
• Market forces
• Conflict of interests
• Society perceives a loss of professionalism in
  physicians

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• There is a new trend to teach professionalism in
  medical schools
• The AAMC Medical Schools Objective Project
  defines the professional attributes a student
  should possess at the time of graduation
• The ACGME defines professionalism as one of the
  core competencies a resident should possess

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• LCME ED-23
• A medical school must teach medical ethics and
  human values, and require its students to exhibit
  scrupulous ethical principles in caring for
  patients, and in relating to patients families
  and to others involved in patient care
• Scrupulous ethical principles honesty,
  integrity, confidentiality, respect

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• ABIM Foundation, ACP-ASIM Foundation and European
  Federation of Internal Medicine created A
  Physician Charter Medical Professionalism in the
  New Millennium

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A PHYSICIAN CHARTER

• Fundamental Principles
• Primacy of patient welfare
• Patient autonomy
• Social justice

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A PHYSICIAN CHARTER

• Set of Professional Responsibilities
• Commitment to professional competence
• Commitment to honesty with patients
• Commitment to patient confidentiality
• Commitment to maintaining appropriate relations
  with patients
• Commitment to improving quality of care
• Commitment to improving access to care
• Commitment to a just distribution of finite
  resources

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• Commitment to scientific knowledge
• Commitment to maintaining trust by managing
  conflicts of interest
• Commitment to professional responsibilities

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Curriculum Development

• The UPR AOA Chapter undertook as their special
  project the development of a Professionalism
  Curriculum
• The overall goal of the curriculum is to
  introduce the basic aspects of professionalism
  throughout the four years of medical school and
  influence students attitudes and behaviors

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Phase I 2003-2004

• First Year Medical Students (Class of 2007)
  during the Introduction to Clinical Skills Course

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• Teaching Strategies
• Anonymous survey based on vignettes of common
  ethical issues
• Grand Round Charter on Medical Professionalism,
  Film The Choice is Yours, reflection and
  discussion period
• Small group discussions based on vignettes
  illustrating various principles of professional
  conduct
• Repetition of initial survey

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• Evaluation Strategies
• Comparison of anonymous survey results
• Faculty evaluation of the small group discussions
  
• Student evaluation of the teaching strategies

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• Results of Phase I
• Students found the curriculum appropriate and
  necessary
• Faculty found the students interested, motivated
  and well informed

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• Changes since 2003
• Introductory lecture on Professionalism
• Evaluation of professional attitudes and
  behavior during clinical activities

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Phase II 2004-2005

• Second year medical students (class of 2007)
  during the Integration Seminar Workshop Series
• Teaching Strategies
• PBL case work on Conflicts of Interest or ethical
  issues
• Two sessions for discussion

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• Evaluation Strategies
• Student evaluation of exercise
• Faculty evaluation of exercise
• Results
• Agreement by students on the need to cover this
  subject in the curriculum
• Evaluated as excellent teaching strategies by
  students
• Faculty reports lively and in-depth participation
  from the students

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Phase III 2005-2006

• Third year medical students (Class of 2007)
  during the Internal Medicine Clerkship

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• Teaching Strategies
• Professionalism Workshop
• Live interview of 3 patients by an attending
  physician
• Small group discussion of the interviews with key
  questions to guide the discussion
• Development of a summary of aspects discussed
  with a list of professionalism issues and
  recommendations on how to manage the issues

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• Evaluation Strategies
• Student evaluation of the exercises
• Only one group has evaluated the activity up to
  now
• Students evaluated the activity as excellent
• Faculty evaluation of the exercises
• Evaluation of professional attitudes incorporated
  into the students evaluations
• Case presentation, rounds, etc

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Faculty Development

• Activities for faculty development in teaching
  and modeling professionalism are being developed
• Faculty is being trained to teach professionalism
  using a PBL approach and a small group session
  approach

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Conclusions

• A curriculum on professionalism can be introduced
  within the medical school curriculum
• A step-wise manner and ownership by a course or
  clerkship seems to help in the implementation
  process
• Continuum through the four years reinforces the
  objectives

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Next

• Development of fourth year medical students
  activities
• Exit evaluation of the project
• We hope these interventions will result in
  enhanced awareness and compliance with
  professional behavior.