Teaching, Promoting and Assessing Professionalism: Can The Physician Charter Help? Linda L. Blank Penn State College of Medicine July 21, 2003

The Physician Charter serves as a framework for contemplating contemporary Professionalism

Do These General Perceptions Resonate With You? We live in a time of unprecedented change We live in a questioning society Professions and medicine have lost status We will not return to the golden period The future will depend in part on how medicine responds Professionalism is the key to public trust

Physician Charter: What Difference Can It Make? PROFESSION Re-emphasizes the central nature of Professional Conduct in training and practice GENERAL PUBLIC Contributes to re-establishing trust between Physicians and Patients

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.

COMPONENTS OF PROFESSIONALISM Individual Collective Knowledge Develop standards Education Foster research Ensure integrity of knowledge base Proper use of resources Ensure access Promote social justice Self regulation set and maintain standards discipline Economic and political Advise public Competence Commitment Altruism Integrity and honesty Morality and ethics Autonomy Teamwork Self regulation Responsibility to society Responsibility to the profession Service Accountability Drs. Richard and Sylvia Cruess

DEFINING 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.” Drs. Richard and Sylvia Cruess Derived from Oxford English Dictionary and literature on Professionalism

Attributes Professional Healer Physician Healer Professional Self-regulation Responsibility to society to the profession Team work Autonomy Caring and compassion Insight Openness Respect for the healing function Respect patient dignity and autonomy Presence Competence Commitment Altruism Integrity and honesty Morality and ethics Healer Professional Drs. Richard and Sylvia Cruess

The Charter’s Principles Attributes Primacy of Patient Welfare Patient Autonomy Social Justice Commitment Altruism Presence Respect patient dignity and autonomy Caring and compassion Openness Responsibility to society

Charter’s Commitments Attributes Professional Competence Honesty with Patients Competence Self-regulation Teamwork Morality and ethics Integrity and honesty Respect for the healing function Respect for patient dignity and autonomy

Charter’s Commitments Attributes Patient Confidentiality Maintaining Appropriate Relations with Patients Commitment Morality and ethics Respect patient dignity and autonomy Responsibility to the profession Insight

Charter’s Commitments Attributes Improving Quality of Care Improving Access to Care Self-regulation Responsibility to society Responsibility to the profession

Charter’s Commitments Attributes Just Distribution of Finite Resources Scientific Knowledge Responsibility to society Responsibility to profession Self-regulation Autonomy Competence

Charter’s Commitments Attributes Managing Conflicts of Interest Professional Responsibilities Integrity and honesty Morality and ethics Altruism Responsibility to the profession Self-regulation

A Notable Quotable on Assessment “That which we can measure, we can more readily improve.” David Leach, MD Executive Director, ACGME

How Can Professionalism Be Evaluated? I. Examinations II. Program Director Ratings III. Structured Evaluations (Mini-CEX) IV. Peer and Patient Ratings V. Professional Portfolios

I. Examinations Impaired physicians (duty to report) Spouse/elder abuse Respect (patient’s right to refuse treatment) Abuse of power (inappropriate physician-patient relationships) Confidentiality (pregnancy/HIV)

II. Program Director Ratings Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice Overall Clinical Competence

Structured Evaluation: The Mini-CEX

Quality Improvement Plan IV. Patient and Peer Assessment Select raters: Distribute surveys; Use interactive voice response system to complete Report 10 Peers 25 Patients Self-Assessment Quality Improvement Plan

V. Professional Portfolios A Promising Strategy to: Show evidence of competence Promote self-reflection Stimulate self-directed learning Foster a healthy professional lifestyle that leads to achieving long-term career goals

How Can Professionalism Be Taught? Role Models, Role Models, Role Models Didactics on History of Medicine, Self-Regulation and Public Policy Small Group Discussions Grand Rounds Named Lectures Morning Report, Noon Conferences Clinical Vignettes Reflective Exercises Self-Assessment/Narratives

How Can Professionalism Be Rewarded? Feeling Good About a Job Well Done Performance Reviews Named Lectureships Local and National Recognition Awards

Develop awards to honor those at Penn State College of Medicine who demonstrate the principles and commitments of the Charter on Medical Professionalism.