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Development of Professionalism and Fitness to Practice Trudie Roberts Kathy Boursicot.

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Presentation on theme: "Development of Professionalism and Fitness to Practice Trudie Roberts Kathy Boursicot."— Presentation transcript:

1 Development of Professionalism and Fitness to Practice Trudie Roberts Kathy Boursicot

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

3 Professionalism in the 21 st Century

4 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 Devil’s Dictionary

5 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

6 The Present “A place of multiple realities” D.J. Cottrell 2000

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8 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 howmedicine responds

9 Present Challenges The changing healthcare system Issues of professional competence Quality assurance

10 The Changing Healthcare System The changing focus of patient treatment The changing focus of illness The changes in society* The change in public expectations*

11 Changing value systems Libertarian Utilitarian Communitarian

12 The Changing Composition of Societies Population movement Globalisation and migration Development of cultural diversity within geographical regions

13 The Change in Public Expectations Consumer society Empowerment Choice Informed public Increased access to information media

14 Competing models Professionalism Consumerism Regulation Management Accountability

15 Changing world of work Unique point in time – 4 distinct groups of workers Duxbury 2002

16 Types Traditionalists Baby boomers Generation X Generation Y

17 Pre 1946 Traditionalists Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty

18 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

19 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

20 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

21 How do each of these groups interpret professionalism?

22 Can professionalism survive?

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24 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 Devil’s Dictionary

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

26 Workshop format Setting the scene – Professionalism in the 21 st century Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary

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28 Definitions (1) UK’s 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

29 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

30 Definitions (3) Calman “The Profession of Medicine” High ethical standards CPD, change and improvement, R&D Teamwork Health as well as illness Concern with clinical effectiveness & outcomes Ability to communicate

31 What do we mean by Professionalism ? Six Domains : Ethical practice Reflection / self awareness Responsibility for actions Respect for patients Working with others Social responsibility

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

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34 NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM O NAÏVE N O NAÏVE N NAIVENAIVE PHRONESISPHRONESIS Y1 Y2 Y3 Y4 Y5 Q Reg  PGT PBL SDL EXPERIENCE MATURITY +ve ROLE MODELS

35 NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM O NAÏVE N O NAÏVE N CYNICALCYNICAL IDEALISTICIDEALISTIC Y1 Y2 Y3 Y4 Y5 Q Reg  PGT BAD EXPERIENCES ADDICTIVE BEHAVIOURS -ve ROLE MODELS POLITICS FATIGUE

36 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

37 NEW MEDI- CAL STUDENT MATURE PROFESSIONAL PERIOD OF PROTO-PROFESSIONALISM O NAÏVE N O NAÏVE N DECAY  ACQUISITION 

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

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40 Knows Knows how Shows how Behaviour~ skills/attitudes Cognition~ knowledge Model of competence Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67. Does Professional authenticity

41 Climbing the pyramid Knows Shows how Knows how Does Knows Factual tests: MCQ, essay type, oral….. Knows how (Clinical) Context based tests: EMQ, essay type, oral….. Shows how Performance assessment in vitro: OSCE, SP-based test….. Does Performance assessment in vivo: Work based assessment, Video, Audits

42 New skills emphasized learning how to learn self-appraisal leadership team skills metacognition professionalism reflectiveness/reflexiveness…….

43 Extending the pyramid Knows Shows how Knows how Does Knows Knows how Shows how Does “Meta” skills

44 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……..

45 How to assess “meta-skills”?  Basic method: Information gathering relying more on descriptive and qualitative judgemental information

46 Workshop format Setting the scene – Professionalism in the 21 st centuary Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary

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