1. Teaching and Evaluating Physicianship
The Healer The Professional

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

3. What is Physicianship?

4. The Physician Has Two Roles
Healer
Professional

5. The two roles
Served simultaneously.
Analyzed separately.

6. The concept of the healer The concept of the professional
Professionalism and Medicine
The concept of the healer
The concept of the professional
Middle ages
“Learned professions”
clergy, law, medicine
1850: Legislation
1900: University linkage
The Present
Antiquity
Hippocrates
technology
“curing”
The Present
Code of
Ethics
Science

7. Medicine’s 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
>
Bureaucratic
Free Market
Neither Share the Values of the Healer
none pure

11. The Social Contract TRUST Medicine Society
fulfill the role of the healer
guaranteed competence
altruistic service
morality and integrity
promotion of the public good
openness
accountability
Society
monopoly
autonomy
trust and respect
self-regulation
adequate resources
status and rewards
financial
non-financial
TRUST

12. The social contract in health care hinges on professionalism.
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.
They must be taught.

14. To Heal Oxford English Dictionary
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
“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. Attributes Professional Healer Caring and compassion Insight Openness
Respect for the
healing function
Respect patient
dignity and
autonomy
Presence
Autonomy
Self-regulation
Responsibility
to society
Team work
Competence
Commitment
Confidentiality
Altruism
Integrity and honesty
Morality and ethics
Responsibility to the
profession
Professional
Healer

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

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

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.
Support of Dean’s Office and Chairs.
Multiple techniques of teaching.
The International Charter
formal teaching
small groups
independent activities
role models - attendings
- residents
other

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

22. Faculty Development 1) Teaching Professionalism - think tank (20)
2) Teaching Professionalism: Dean’s 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 for all residents (CanMeds)
Body Donor Service:
Prof 101 followed by small groups:
Elective: The Profession and Society: 1999
White Coat Ceremony:
Mandatory half day on professionalism 2000
for all residents (CanMeds)
Professionalism 101 to incoming students 2003
201 to 1st year students 2004
20 students
Pledge

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

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

26. Four Committees The Healer The Professional Evaluation
Post Graduate Education

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

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

30. Content Whole 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) pre-clinical clinical
humanism/narrative medicine
spirituality
palliative care medicine
community service
portfolio (self-reflection, self-assessment)

32. Evaluation ALL ATTRIBUTES MUST BE EVALUATED USING AT LEAST ONE METHOD
longitudinal - 4 years
multiple 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.
Must start with agreed-upon definitions.
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.

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