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Teaching and Evaluating Physicianship The HealerThe Professional.

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Presentation on theme: "Teaching and Evaluating Physicianship The HealerThe Professional."— Presentation transcript:

1 Teaching and Evaluating Physicianship The HealerThe Professional

2 Work in Progress What we have accomplished What we have accomplished Our hopes for the future Our hopes for the future

3 What is Physicianship?

4 The Physician Has Two Roles Healer Healer Professional Professional

5 The two roles The two roles Served simultaneously.Served simultaneously. Analyzed separately.Analyzed separately.

6 AntiquityHippocratestechnologycuring The Present Professionalism and Medicine The concept of the healer The concept of the professional Code of Ethics Middle ages Learned professions clergy, law, medicine 1850: Legislation 1900: University linkage The Present Science

7 Medicines Values Are Derived From Both The Healer and the Professional

8 The Primary Role is that of the Healer

9 Society uses the concept of the professional as a means of organizing the delivery of complex services which it requires, including that of the healer. The Professional Model

10 Other Models are Available BureaucraticBureaucratic Free MarketFree Market Neither Share the Values of the Healer none pure >

11 The Social Contract Medicine fulfill the role of the healer fulfill the role of the healer guaranteed competence guaranteed competence altruistic service altruistic service morality and integrity morality and integrity promotion of the public good promotion of the public good openness openness accountability accountability Society monopolymonopoly autonomyautonomy trust and respecttrust and respect self-regulationself-regulation adequate resourcesadequate resources status and rewardsstatus and rewards financial financial non-financial non-financial TRUST

12 The social contract in health care hinges on professionalism.The social contract in health care hinges on professionalism. It serves as the basis for the expectations of both medicine and society.It serves as the basis for the expectations of both medicine and society.

13 To preserve values in changing times, Physicians must understand the linked roles of the healer and the professional.To preserve values in changing times, Physicians must understand the linked roles of the healer and the professional. They must be taught.They must be taught.

14 To Heal To make whole or sound in bodily conditions; to free from disease or ailment, to restore to health or soundness. Oxford English Dictionary

15 Definition Profession Definition Profession An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society. Derived from the Oxford English Dictionary and the Literature on Professionalism In Press, Teaching and Learning in Medicine

16 CompetenceCommitmentConfidentialityAltruism Integrity and honesty Morality and ethics Responsibility to the profession profession AutonomySelf-regulationResponsibility to society to society Team work Caring and compassion InsightOpenness Respect for the healing function healing function Respect patient dignity and dignity and autonomy autonomyPresence

17 Each attribute will be reflected (or not) by appropriate (or inappropriate) behavior.Each attribute will be reflected (or not) by appropriate (or inappropriate) behavior. These behaviors can be observed and evaluated.These behaviors can be observed and evaluated.

18 How to impart knowledge of Physicianship to students and residents.How to impart knowledge of Physicianship to students and residents. How to encourage behavior characteristic of the good physician.How to encourage behavior characteristic of the good physician. The Challenge

19 By concentrating on the role of the Professional we risk neglecting that of the Healer - in spite of overlap THEY ARE DIFFERENT

20 General Principles Integrated approach throughout faculty for undergraduate and postgraduate education.Integrated approach throughout faculty for undergraduate and postgraduate education. Support of Deans Office and Chairs.Support of Deans Office and Chairs. Multiple techniques of teaching.Multiple techniques of teaching. » The International Charter » formal teaching » small groups » independent activities » role models - attendings - residents - residents » other

21 General Principles Evaluate what is taught.Evaluate what is taught. The International Charter Faculty and Resident development essential.Faculty and Resident development essential.

22 Faculty Development 1) Teaching Professionalism - think tank (20) 2) Teaching Professionalism: Deans Invitation (40) 3) Evaluating Professionalism - think tank (20) 4) Evaluating Physicianship - (90) Behaviors Identified 150 Faculty members and residents have participated. Large pool of trained teachers and role models.

23 McGill: 1996 - 2003 Body Donor Service:1992Body Donor Service:1992 Prof 101 followed by small groups:1997Prof 101 followed by small groups:1997 Elective: The Profession and Society:1999Elective: The Profession and Society:1999 White Coat Ceremony:2000White Coat Ceremony:2000 Mandatory half day on professionalism2000Mandatory half day on professionalism2000 for all residents (CanMeds) Professionalism 101 to incoming students2003Professionalism 101 to incoming students2003 201 to 1st year students2004 Pledge 20 students

24 teaching episodic ineffective ineffective evaluation methods primitive ineffective ineffective the role of the healer not addressed explicitly. Assessment:

25 Program on Physicianship to teach the role of the Healer and The Professional.to teach the role of the Healer and The Professional. to promote behaviors characteristic of both.to promote behaviors characteristic of both. to evaluate knowledge of both rolesto evaluate knowledge of both roles to evaluate behaviors characteristic of both.to evaluate behaviors characteristic of both.

26 Four Committees The Healer The Professional Evaluation Post Graduate Education

27 Recommendations A longitudinal program on physicianship throughout 4 years of medical school.A longitudinal program on physicianship throughout 4 years of medical school. Distinct approaches to the Healer and the Professional.Distinct approaches to the Healer and the Professional. Incorporate existing activities including ethics.Incorporate existing activities including ethics. Create new learning experiences.Create new learning experiences. Revise evaluation system - global rating scaleRevise evaluation system - global rating scale - miniCEX - miniCEX All students must successfully complete program.All students must successfully complete program. Undergraduate

28 Recommendations All residents must master the cognitive base of professionalism.All residents must master the cognitive base of professionalism. Self reflection must be promotedSelf reflection must be promoted - small groups - ? portfolios revise evaluation systemrevise evaluation system - global rating scale - miniCEX Postgraduate

29

30 Content Whole class (Flagship) activities at regular intervalsWhole class (Flagship) activities at regular intervals – Lectures small groups – ethics small groups – introduction to the cadaver small groups – body donor service – white coat ceremony – 4th year seminars

31 Content unit specific activities (small group)unit specific activities (small group)pre-clinicalclinical humanism/narrative medicinehumanism/narrative medicine spiritualityspirituality palliative care medicinepalliative care medicine community servicecommunity service portfolio (self-reflection, self-assessment)portfolio (self-reflection, self-assessment)

32 Evaluation longitudinal - 4 yearslongitudinal - 4 years multiple methodsmultiple methods – knowledge - mcq etc. - (do often) – global rating scale - UCSF, Maastrict – critical incidents – portfolio – ? MiniCEX ALL ATTRIBUTES MUST BE EVALUATED USING AT LEAST ONE METHOD

33 Faculty Development – essential - includes residents – knowledge role modeling – evaluation Requires resources

34 Resources Assoc/Assist Dean for Physicianship Infrastructure Support - financial and other

35 Summary The role of the Healer and the Professional must be taught.The role of the Healer and the Professional must be taught. Must start with agreed-upon definitions.Must start with agreed-upon definitions. The teaching of physicianship should represent a major commitment of the faculty.The teaching of physicianship should represent a major commitment of the faculty. It should be taught and evaluated in a planned way throughout the curriculum.It should be taught and evaluated in a planned way throughout the curriculum.

36 The most important problem for the future of professionalism is neither economic nor structural but cultural and ideological. The most important problem is its soul Freidson, 2001


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