Development of Professionalism and Fitness to Practice Trudie Roberts Kathy Boursicot

Workshop format Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary

Professionalism in the 21st Century

The Past A. Bierce from The Devil’s Dictionary “The past is that part of eternity with some small fraction of which we have a slight and regrettable acquaintance” A. Bierce from The Devil’s Dictionary

The past – ‘a golden age’ Patients were passive and grateful Regulation of doctors was controlled by doctors themselves Public accountability was negligible Social prestige was high

“A place of multiple realities” The Present “A place of multiple realities” D.J. Cottrell 2000

The Present A time of unprecedented change No return to the golden age A questioning society Professions including medicine have lost status Professionalism is the key to public trust The future will depend in part on how medicine responds

Present Challenges The changing healthcare system Issues of professional competence Quality assurance

The Changing Healthcare System The changing focus of patient treatment The changing focus of illness The changes in society* The change in public expectations*

Changing value systems Libertarian Communitarian Utilitarian

The Changing Composition of Societies Population movement Globalisation and migration Development of cultural diversity within geographical regions

The Change in Public Expectations Consumer society Empowerment Choice Informed public Increased access to information media

Competing models Professionalism Consumerism Regulation Management Accountability

Changing world of work Unique point in time – 4 distinct groups of workers Duxbury 2002

Types Traditionalists Baby boomers Generation X Generation Y

Pre 1946 Traditionalists Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty

1947- 1972 Baby Boomers Workaholics Accept stress as part of the job Used to belt tightening and sacrifice Work predicated on delayed gratification Value titles and status symbols

1968 – 1980 Generation X Place more importance on career than personal life Mistrustful and suspicious of employers Products of downsizing and cost cutting Usually had experience of many jobs Not committed to a particular company Want immediate gratification

1980 – 1995 Generation Y Want a balance of work and personal life Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expanding job market and shrinking work force Expect and get immediate reward

How do each of these groups interpret professionalism?

Can professionalism survive?

The Future “The future is that period of time in which our affairs prosper, our friends are true, and our happiness is assured” A. Bierce from The Devil’s Dictionary

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.

Workshop format Defining professionalism Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary

Definitions (1) UK’s GMC Duties of a Doctor Good Medical Practice CanMEDS Medical expert, communicator, collaborator, manager, health advocate, scholar, professional ABIM/ACP/EFIM – “A Physician Charter” Patient welfare Patient autonomy Social justice

Definitions (2) Swick Cruess & Cruess Cosgrove Need for a definition 9 professional behaviours Cruess & Cruess Physician as Healer / as Professional Damaged social contract Cosgrove Professionalism – state not trait

Definitions (3) Calman “The Profession of Medicine” High ethical standards CPD, change and improvement, R&D Teamwork Health as well as illness Concern with clinical effectiveness & outcomes Ability to communicate

What do we mean by Professionalism? Six Domains: Ethical practice Reflection / self awareness Responsibility for actions Respect for patients Working with others Social responsibility

Workshop format How to teach professionalism? Setting the scene – Professionalism in the 21st centuary Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary

PERIOD OF PROTO-PROFESSIONALISM NEW MEDICAL STUDENT PERIOD OF PROTO-PROFESSIONALISM MATURE PROF- ESSIONAL MATURITY PHRONESIS EXPERIENCE SDL NAIVE PBL +ve ROLE MODELS Y1 Y2 Y3 Y4 Y5 Q Reg  PGT NAÏVE N O

PERIOD OF PROTO-PROFESSIONALISM NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM IDEALISTIC BAD EXPERIENCES -ve ROLE MODELS FATIGUE CYNICAL POLITICS ADDICTIVE BEHAVIOURS Y1 Y2 Y3 Y4 Y5 Q Reg  PGT NAÏVE N O

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

ACQUISITION  DECAY  PERIOD OF PROTO-PROFESSIONALISM NEW MEDI- CAL STUDENT MATURE PROFESSIONAL ACQUISITION  DECAY  NAÏVE N O

Workshop format Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary

Model of competence Does Shows how Knows how Knows Behaviour~ skills/attitudes Does Professional authenticity Shows how Knows how Cognition~ knowledge Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

Climbing the pyramid...... Does Does Shows how Shows how Knows how Performance assessment in vivo: Work based assessment, Video, Audits Does Shows how Performance assessment in vitro: OSCE, SP-based test….. Shows how Knows how (Clinical) Context based tests: EMQ, essay type, oral….. Knows how Knows Factual tests: MCQ, essay type, oral….. Knows

New skills emphasized learning how to learn self-appraisal leadership team skills metacognition professionalism reflectiveness/reflexiveness…….

Extending the pyramid Knows Shows how Knows how Does “Meta” skills

How to assess “meta-skills”? Self assessment Peer assessment Co-assessment (combined self, peer, teacher assessment) Patient ratings Log book/diary Structured evaluations (mini cex etc) Portfolio assessment……..

How to assess “meta-skills”? Basic method: Information gathering relying more on descriptive and qualitative judgemental information

Workshop format Setting the scene – Professionalism in the 21st centuary Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary

Thank you