4 The Past A. Bierce from The Devil’s Dictionary “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 gratefulRegulation of doctors was controlled by doctors themselvesPublic accountability was negligibleSocial prestige was high
6 “A place of multiple realities” The Present“A place of multiple realities”D.J. Cottrell 2000
8 The Present A time of unprecedented change No return to the golden age A questioning societyProfessions including medicine have lost statusProfessionalism is the key to public trustThe future will depend in part on how medicine responds
9 Present Challenges The changing healthcare system Issues of professional competenceQuality assurance
10 The Changing Healthcare System The changing focus of patient treatmentThe changing focus of illnessThe changes in society*The change in public expectations*
11 Changing value systems LibertarianCommunitarianUtilitarian
12 The Changing Composition of Societies Population movementGlobalisation and migrationDevelopment of cultural diversity within geographical regions
13 The Change in Public Expectations Consumer societyEmpowermentChoiceInformed publicIncreased access to informationmedia
15 Changing world of workUnique point in time – 4 distinct groups of workersDuxbury 2002
16 TypesTraditionalistsBaby boomersGeneration XGeneration Y
17 Pre 1946 Traditionalists Totally committed to the ‘company’ Horrified by unemploymentWould go down with the shipTypified by unquestioning loyalty
18 1947- 1972 Baby Boomers Workaholics Accept stress as part of the job Used to belt tightening and sacrificeWork predicated on delayed gratificationValue titles and status symbols
19 1968 – 1980 Generation XPlace more importance on career than personal lifeMistrustful and suspicious of employersProducts of downsizing and cost cuttingUsually had experience of many jobsNot committed to a particular companyWant immediate gratification
20 1980 – 1995 Generation Y Want a balance of work and personal life Take time off for personal life enhancementDemand flexible environments and benefitsDo not expect a job for lifeExpanding job market and shrinking work forceExpect and get immediate reward
21 How do each of these groups interpret professionalism?
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 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 Defining professionalism Setting the scene – Professionalism in the 21st centuryDefining professionalismHow to teach professionalismHow to assess professionalism and ensure fitness to practiceSummary
28 Definitions (1) UK’s GMC Duties of a Doctor Good Medical Practice CanMEDSMedical expert, communicator, collaborator, manager, health advocate, scholar, professionalABIM/ACP/EFIM – “A Physician Charter”Patient welfarePatient autonomySocial justice
29 Definitions (2) Swick Cruess & Cruess Cosgrove Need for a definition 9 professional behavioursCruess & CruessPhysician as Healer / as ProfessionalDamaged social contractCosgroveProfessionalism – state not trait
30 Definitions (3) Calman “The Profession of Medicine” High ethical standardsCPD, change and improvement, R&DTeamworkHealth as well as illnessConcern with clinical effectiveness & outcomesAbility to communicate
31 What do we mean by Professionalism? Six Domains:Ethical practiceReflection / self awarenessResponsibility for actionsRespect for patientsWorking with othersSocial responsibility
32 Workshop format How to teach professionalism? Setting the scene – Professionalism in the 21st centuaryDefining professionalismHow to teach professionalism?How to assess professionalism and ensure fitness to practice?Summary
34 PERIOD OF PROTO-PROFESSIONALISM NEWMEDICAL STUDENTPERIOD OF PROTO-PROFESSIONALISMMATURE PROF- ESSIONALMATURITYPHRONESISEXPERIENCESDLNAIVEPBL+ve ROLEMODELSY Y Y Y Y Q Reg PGTNAÏVE NO
35 PERIOD OF PROTO-PROFESSIONALISM NEWMEDICAL STUDENTMATURE PROF- ESSIONALPERIOD OF PROTO-PROFESSIONALISMIDEALISTICBAD EXPERIENCES-ve ROLE MODELSFATIGUECYNICALPOLITICSADDICTIVE BEHAVIOURSY Y Y Y Y Q Reg PGTNAÏVE NO
36 How Can Professionalism Be Taught? Role ModelsDidactics on History of Medicine, Self-Regulation and Public PolicySmall Group DiscussionsGrand RoundsNamed LecturesTeaching ward roundsClinical VignettesReflective ExercisesSelf-Assessment/Narratives
37 ACQUISITION DECAY PERIOD OF PROTO-PROFESSIONALISM NEW MEDI- CAL STUDENTMATUREPROFESSIONALACQUISITION DECAY NAÏVE NO
38 Workshop formatSetting the scene – Professionalism in the 21st centuryDefining professionalismHow to teach professionalism?How to assess professionalism and ensure fitness to practice?Summary
40 Model of competence Does Shows how Knows how Knows Behaviour~ skills/attitudesDoesProfessional authenticityShows howKnows howCognition~knowledgeKnowsMiller GE. The assessment of clinical skills/competence/performance.Academic Medicine (Supplement) 1990; 65: S63-S67.
41 Climbing the pyramid...... Does Does Shows how Shows how Knows how Performance assessment in vivo:Work based assessment, Video, AuditsDoesShows howPerformance assessment in vitro:OSCE, SP-based test…..Shows howKnows how(Clinical) Context based tests:EMQ, essay type, oral…..Knows howKnowsFactual tests:MCQ, essay type, oral…..Knows
42 New skills emphasized learning how to learn self-appraisal leadership team skillsmetacognitionprofessionalismreflectiveness/reflexiveness…….
43 Extending the pyramidKnowsShows howKnows howDoes“Meta” skills
44 How to assess “meta-skills”? Self assessmentPeer assessmentCo-assessment (combined self, peer, teacher assessment)Patient ratingsLog book/diaryStructured 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 formatSetting the scene – Professionalism in the 21st centuaryDefining professionalismHow to teach professionalismHow to assess professionalism and ensure fitness to practiceSummary
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