WHAT PROFESSIONALISM CAN LEARN FROM BIOCHEMISTRY Steven A WHAT PROFESSIONALISM CAN LEARN FROM BIOCHEMISTRY Steven A. Wartman, MD, PhD, MACP President/CEO Association of Academic Health Centers Presented to the Professionalism Task Force of the University of South Alabama April 24, 2008

Albert L. Lehninger (1917-1986)

Hans A. Krebs (1900-1981)

The “Krebs Cycle” Challenge How can we ensure a common outcome in terms of progression of values for the incredibly varied group of individuals entering our education and training programs?

The Learning Environment-1 The Strong Forces Accreditation Testing Licensure

Wartman SA, Littlefield JH Wartman SA, Littlefield JH. Changes in the US medical licensure examination and impact on US medical schools. Research Letter. JAMA 2005;293:424-425.

The Learning Environment-2 The Local Philosophy and Reality Resources and priority Faculty incentives Traditional approach Curriculum committee Disciplinary pressure

The Learning Environment-3 Calls for new curricula 2001-2004 alternative therapies, bioterrorism, cardiothoracic radiology, chronic illness, cross-cultural education, emergency psychiatry training, end-of-life care, geriatrics, medical humanities, musculoskeletal medicine, palliative care, stroke, and women’s health

The Substrate-1 The students Variety of perspectives, attitudes, skills, motivation, personalities, beliefs, and even values

The Substrate-2 Service versus education conflict External Regulation Faculty and other role models

“Culture eats strategy for lunch over and over again”

Some Questions To Consider How do our health professions programs embrace and acculturate such a varied group of individuals?

Some Questions To Consider How do we inculcate the idea of giving oneself in the service of others while learning?

Some Questions To Consider Are we churning out superficially similar products that are able to pass the necessary board exams and go on with their careers, but who exhibit markedly different degrees of arguably the most important goal of health professions education: professionalization?

Professionalism In the end professionalism means “acting rightly when the right path is clear before us but other pressing needs and desires pull us away… [and] taking the time and making the effort to do the right thing when the path of least resistance would be to take an easier way out…”1 1. Huddle TS. Teaching professionalism: is medical morality a competency? Acad Med 2005;80(10):885-891.

What is not so apparent is the existence of a code of conduct that runs deep throughout the program and impacts the participants so that by graduation it has become part of their professional identity

The Centrality Of Professionalism It’s what separates health professions education from a trade school It’s essential for the public trust It’s absolutely critical for the clinician-patient relationship

So How Can Professionalism Be Taught? Not by using conventional means It is a long, slow and deliberate process that must be constantly reinforced It values the importance of personal experience and emotion in professional development

The Challenge If our goal is to produce graduates deeply steeped in the ethos of professionalism, then our challenge is to find a common pathway to clinical practice that inculcates life long professionalism

“It is indeed remarkable that all foodstuffs are burnt through a common pathway.”

In his Nobel Lecture of December 11, 1953, Krebs pointed out his “astonishment” that, in spite of a multitude of sources of energy, the number of steps where energy is utilized is small – only seven.

Some Caveats This is not something that an orientation program or seminar will solve It requires an ongoing, constant commitment It starts from the top down And, it needs to be highly individualized and personalized

The Seven Step Program Step 1 Model professionalism from the top down Begin with the vice president, deans, department chairs, program directors and eventually involve all the faculty

The Seven Step Program Step 2 View professionalism as consistently important from day one to graduation Be relentless

The Seven Step Program Step 3 Get to know the individual student and trainee Why? Because the transformation we seek is a highly personal one

The Seven Step Program Step 4 Build flexibility into your program Each student and trainee has different needs, strengths, weaknesses, etc Eschew the “cookie cutter” approach

The Seven Step Program Step 5 Provide regular and timely personal feedback and combine self-assessment with outside evaluation

The Seven Step Program Step 6 Provide an ongoing safe venue to share experiences and enhance personal awareness

The Seven Step Program Step 7 Commit your program to the provision of community service above and beyond the regular educational experiences

“To have results you’ve never had, you must do things you’ve never done”

“Out of the chaos of isolated reactions Krebs succeeded in extracting the basic system for the essential pathway of oxidation process within the cell.”

“His penetrating intuition was so clear and true and his grasp of the problem so keen from the start that none of his original ideas had to be revised.”

What will you do to step up to answer the call?