Assessment of professionalism Ethics in professional practice Professor Rona Patey University of Aberdeen r.patey@abdn.ac.uk

Definition of professionalism Numerous definitions……..but uncertainty remains ‘Medical professionalism signifies a set of values, behaviours and relationships that underpins the trust the public has in doctors with doctors being committed to integrity, compassion, altruism, continuous improvement, excellence & teamwork’ Royal College of Physicians 2005

Supporting the development of professionalism Curriculum design Student selection Teaching & learning methods Role modeling Assessment methods Passi et al Medical Education 2010

Why assess professionalism? Post-grad disciplinary action strongly associated with prior ‘unprofessional behaviours’ as an undergraduate Severe irresponsibility Severely limited capacity for self improvement Papadakis et al 04 & 05 Requirement for students to demonstrate professionalism by regulators Most complaints about conduct not competence Present behaviour can predict future actions Doesn’t osmose All clinicians vulnerable to lapses in professional behaviour & can benefit from explicit attention to this domain Evidence that there may be a deterioration in professional attitudes from idealism to cynicism

Assessment of professionalism Many instruments described No single instrument for all aspects of professionalism Multidimensional approach Aim to track attitudes throughout curriculum Workplace based assessment desirable with multiple assessors in multiple clinical settings

Methods of assessing professionalism Peer assessment Direct observation Patient evaluations OSCE Standardised patient assessments Student evaluation Reflective writing Self assessment Educational portfolios Teamwork exercises P-MEX Attendance / work records Video analysis Situational judgement test

Ethics in professional practice Two points of view on teaching ethics Means of creating virtuous clinicians Means of providing clinicians with the skill set to analyse and resolve ethical dilemmas Work required to delineate core content, core processes, core skills

UoA Ethics teaching Professional & ethical code Reflective writing Introduced in Year 1 & signed annually Reflective writing Whole class and small group discussion Clinical practise

UoA Ethics: Y1 4 principles Beneficence Non-maleficence Respect for autonomy Justice Highlight topics of particular relevance for the students: Non-judgmental approach Not imposing personal views & respecting patient views Confidentiality Not exceeding your competency Fitness to practise

UoA Ethics Y2

UoA Y3, Y4 & Y5 Clinical experience Professional practice blocks ( 3 days Y3 / 2 x 2 wks Y5) Ethics case scenarios Medicolegal sessions e.g. mock Fatal accident inquiry

Role models & the learning environment Important in: professional character formation to impart values of the profession Three characteristics of good role models Clinical competence Teaching skills Personal qualities

University of Dundee poster for clinical areas

Our context Students changing cultural contexts Social and system differences Transfer of information on student professionalism What? How?

Questions / discussion