Teaching professionalism to first year medical students using team-based learning   Beth Choby, MD FAAFP Renate Rosenthal, PhD Bill Brescia, Ed D Department of Medical Education University of Tennessee Health Science Center Memphis, TN

Timeline for session Introduction and welcome 5 minutes   Introduction and welcome 5 minutes Participant discussion 5 minutes Didactic presentation 15 minutes TBL scenarios 1-3 10 min each Large group discussion 10 min each Questions and wrap-up 5 minutes

Introductions Dr. Beth Choby, MD FAAFP Dr. Renate Rosethal, PhD Dr. Bill Brescia, EdD

Audience query What methods do you currently use for teaching professionalism in the early medical school curriculum How effective are they?

Professionalism Widely used Carries so many connotations/nuances that meaning is blurred Supreme Court Justice Potter Stewart 1964 “I know it when I see it” Add various graphics of “professionals”

Professionalism- can you define it? Criterion-based approach Profession provides important public service Practice requires considerable skill Draws on body of knowledge exclusive to itself Requires moral component intrinsic to practice and has code of ethics Requires autonomy of practice Needs a strong voice Supreme Court Justice Potter Stewart 1964 “I know it when I see it” Graham C, et al. Widening debate about medical professionalism. Med Education 2013: 47:333-341.

Van der Camp Identified 90 constituent elements of professionalism Three domains: interpersonal, public and intrapersonal professionalism Altruism, accountability, integrity and respect only items commonly cited Suggests a lack of consensus within medical community about definition Van de Camp K, et al. How to conceptualize professionalism: a qualitative study. Med Teach 2004; 26(8):696-702.

LCME Standard MS-31 “A medical education program must ensure that its learning environment promotes the development of explicit and appropriate professional attributes in its medical students (i.e., attitudes, behaviors, and identity)” Liaison Committee on Medical Education: Functions and structure of a medical school Standards for Accreditation of Medical Education Programs Leading to the MD degree. http://www.lcme.org/functions2010jun.pdf

How essential is professionalism training in the pre-clinical years? Unprofessional behavior during medical school associated with subsequent disciplinary action by medical boards Seeing authority figure behaving rudely to a colleague reduced a subject’s performance on both routine and creative tasks (Porath and Erez) Students who witness rude behavior toward fellow student similarly perform worse on memory and creative tasks Kulac E, et al. Medical students’ participation in and perception of unprofessional Behaviors: comparison of preclinical and clinical phases. Adv Physiol Educ 2013; 37:298-302 Porath CL, et al. does rudeness really matter? The effects of rudeness on task performance And helpfulness. Acad Manage J 2007; 50: 1181-1197.

How do students see it? Attributes cited by medical students when asked to define professionalism Add Table 1 from Sullivan p. 257

Byszewski, et al. 2012 “Students want professionalism to have a prominent place at their school, but not necessarily in their didactic curriculum” “Students cringe and feel patronized when professionalism is discussed” Disconnect between faculty and students regarding “professional” behaviors Emailing during class/leaving class early not view by students as unprofessional; current generation of learners with different perspectives of professionalism as it relates to specific behaviors; making expectations explicit is critical

Cuesta-Briand et al. 2014 Main emerging themes from students’ views on professionalism were “adopting professional persona”, adhering to code of practice/professional guidelines, and treating others with respect Professional persona enacted by appropriate dress and detachment when speaking with patients (elicited student dislike and skepticism) Told what to wear as “superficial face” of professionalism Cuesta-Briand B, et al. ‘A world of difference’: a qualitative study of medical students’ Views on professionalism and the ‘good doctor’ BMC Med education 2014;14:77

More student perceptions ‘Good doctor’ ≠ ‘Professional doctor’ Students see as two separate constructs with different characteristics and only some overlap Professionalism “activated on demand to perform as expected” “Professional and ethical chameleons” to navigate training

Overlap areas Respect, communication, team work and adequate knowledge base seen as core to professionalism Internally-motivated behavior ? Starting scaffold for talking with students

Teaching professionalism in medical school Principles of Clinical Medicine course Longitudinal “doctoring” experience New format after curriculum overhaul Went from 1 week experience every 6-8 weeks (block system) to continuous sequential course Classes every semester (4 hours credit) in first two years of medical school (pre-clinical) Professionalism previously taught in large lecture setting ? Student buy in “Preaching” concerns Continued issues with attire and “professionalism” issues

New course= new thinking Curriculum design geared toward flipped classroom and interactive learning We have a beautiful new TBL complex, so… How can we use it? Can you teach professionalism using a TBL format?

Teaching professionalism by TBL Recruited faculty presenters Literature search to identify pre-readings Development of the IRAT/GRAT assessment Scenario development Development of the documentation rubrics

“Life in the morning of a medical student” Please open the designated folder and review the scenario “life in the morning of a medical student” After discussing with your group, complete the provided sheet Time allotment Small group review/discussion 10 minutes Large group discussion 10 minutes

“Life in the afternoon of a medical student” Small group review/discussion 10 minutes Large group discussion 10 minutes

“Later that evening……” Small group review/discussion 10 minutes Large group discussion 10 minutes

What the students said ? Coverage of male vs. female type professionalism issues? Student discussions three months after the TBL

What the faculty saw Attire issues Students able to identify issues that previously might have gone under the radar

Plans for next year Incorporation of student comments and further validation of scenarios Pre- and post-TBL knowledge and attitudes assessment 6 and 12 month follow-up on experiences and knowledge

Questions and networking Please take some time to exchange contact information with people you have met Thank for attending and have a wonderful conference!