Medical Students: Professional Values and Fitness to Practice Tim Crocker-Buqué

Objectives Provide a definition of medical professionalism Discuss how professionalism and fitness to practice are assessed and regulated List some forms of assessments used to assess medical professionalism Understand and discuss some of the issues surrounding common methods of assessing professionalism

“If you wish to converse with me, define your terms” – Voltaire “Perhaps professionalism is like pornography: easy to recognize but difficult to define.” (Herbert and Swick, 2000) “The survey questions are undoubtedly affected by the general lack of a common understanding of the meaning of medical professionalism.” (Swick et al., 1999)

What is professionalism?

Herbert and Swick, 2000 8 aspects: Subordinate own interests to interests of patients. Demonstrate high ethical and moral standards. Behave according to an accepted social contract. Demonstrate humanistic values (such as integrity and honesty; caring and compassion, altruism and empathy, respect for others, and trustworthiness.) Show responsibility and accountability. Have a commitment to improve. Cope with complexity and uncertainty. Demonstrate reflective practice.

General Medical Council - 2009 Came into action March 2009 Produced with student contributions Guidance Enacted by Medical Schools

7 core aspects Good clinical care Maintaining good medical practice Teaching and training, appraising and assessing Relationships with patients Working with colleagues Probity Health

Good clinical care In order to demonstrate that they are fit to practise, students should: (a) recognise and work within the limits of their competence and ask for help when necessary (b) accurately represent their position or abilities (c) make sure they are supervised appropriately for any clinical task they perform

Maintaining good medical practice In order to demonstrate that they are fit to practise, students should: (b) attend compulsory teaching sessions or make other arrangements with the medical school (c) complete and submit course work on time (d) be responsible for their own learning (g) respect the knowledge and skills of those involved in their education

Teaching training, appraising and assessing In order to demonstrate that they are fit to practise, students should: (a) demonstrate basic teaching skills (b) be aware of the principles of education in medicine (c) be willing to contribute to the education of other students

Relationships with patients 25. Doctors and students are expected to maintain a professional boundary between themselves and their patients or anyone close to the patient. They must not use their professional position to cause distress or to exploit patients.

Probity “Probity means being honest and trustworthy, and acting with integrity.” b) be honest, genuine and original in their academic work, including when conducting research, and take effective action if they have concerns about the honesty of others (e) not plagiarise others' work or use their own work repeatedly in a way that could mislead (f) be honest and trustworthy in any financial dealings, especially if they are managing finances, and make sure that any funds are used for the purpose they were intended for

Health It is important that medical students are aware that their own poor health may put patients and colleagues at risk. Students should be registered with a GP to ensure they have access to independent and objective medical care.

Types of assessment… Peer/self assessment (360 degrees) OSCE/Long Case Portfolios/Log books Observation (DOPS/Mini-CEX) Continuous assessment Lynch et al., 2004 – 88 different types of assessment

Validity Reliability Feasability OSCE Clinical vignettes have been used successfully to assess professionalism in undergraduate medical students (Goldie et al. 2004; Boenink et al. 2005) Vs. 360 Degree / Peer assessment (Medical students) Validity Reliability Feasability Pros Cons Arnold et al., 2005; Mazor et al., 2007

www.gmc-uk.org Thank you! Questions?