1.     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

2. Timeline for session Introduction and welcome 5 minutes
Introduction and welcome minutes
Participant discussion minutes
Didactic presentation minutes
TBL scenarios min each
Large group discussion min each
Questions and wrap-up minutes

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

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

5. 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”

6. 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:

7. 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):

8. 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.

9. 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:
Porath CL, et al. does rudeness really matter? The effects of rudeness on task performance
And helpfulness. Acad Manage J 2007; 50:

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

11. 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
ing 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

12. 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

13. 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

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

15. 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

16. 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?

17. 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

18. “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 minutes
Large group discussion minutes

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

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

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

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

23. 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

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