5 The two rolesServed simultaneously.Analyzed separately.
6 The concept of the healer The concept of the professional Professionalism and MedicineThe concept of the healerThe concept of the professionalMiddle ages“Learned professions”clergy, law, medicine1850: Legislation1900: University linkageThe PresentAntiquityHippocratestechnology“curing”The PresentCode ofEthicsScience
7 Medicine’s Values Are Derived From Both The Healer and the Professional
9 Society uses the concept of the professional as a means of organizing the delivery of complex services which it requires, including that of the healer.“The Professional Model”
10 Other Models are Available >BureaucraticFree MarketNeither Share the Values of the Healernone pure
11 The Social Contract TRUST Medicine Society fulfill the role of the healerguaranteed competencealtruistic servicemorality and integritypromotion of the public goodopennessaccountabilitySocietymonopolyautonomytrust and respectself-regulationadequate resourcesstatus and rewardsfinancialnon-financialTRUST
12 The social contract in health care hinges on professionalism. It serves as the basis for the expectations of both medicine and society.
13 To preserve values in changing times, Physicians must understand the linked roles of the healer and the professional.They must be taught.
14 To Heal Oxford English Dictionary To make whole or sound in bodily conditions; to free from disease or ailment, to restore to health or soundness.Oxford English Dictionary
15 Definition Profession “An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.”Derived from the Oxford English Dictionary and the Literature on ProfessionalismIn Press, “Teaching and Learning in Medicine”
16 Attributes Professional Healer Caring and compassion Insight Openness Respect for thehealing functionRespect patientdignity andautonomyPresenceAutonomySelf-regulationResponsibilityto societyTeam workCompetenceCommitmentConfidentialityAltruismIntegrity and honestyMorality and ethicsResponsibility to theprofessionProfessionalHealer
17 Each attribute will be reflected (or not) by appropriate (or inappropriate) behavior. These behaviors can be observed and evaluated.
18 The ChallengeHow to impart knowledge of Physicianship to students and residents.How to encourage behavior characteristic of the good physician.
19 By concentrating on the role of the Professional we risk neglecting that of the Healer - in spite of overlap THEY ARE DIFFERENT
20 General PrinciplesIntegrated approach throughout faculty for undergraduate and postgraduate education.Support of Dean’s Office and Chairs.Multiple techniques of teaching.The International Charterformal teachingsmall groupsindependent activitiesrole models - attendings- residentsother
21 The International Charter General PrinciplesEvaluate what is taught.The International CharterFaculty and Resident development essential.
22 Faculty Development 1) Teaching Professionalism - think tank (20) 2) Teaching Professionalism: Dean’s Invitation (40)3) Evaluating Professionalism - think tank (20)4) Evaluating Physicianship - (90)Behaviors Identified150 Faculty members and residents have participated.Large pool of trained teachers and role models.
23 McGill: 1996 - 2003 for all residents (CanMeds) Body Donor Service:Prof 101 followed by small groups:Elective: The Profession and Society: 1999White Coat Ceremony:Mandatory half day on professionalism 2000for all residents (CanMeds)Professionalism 101 to incoming students 2003201 to 1st year students 200420 studentsPledge
24 Assessment: teaching • episodic • ineffective evaluation • methods primitivethe role of the healer notaddressed explicitly.
25 Program on Physicianship to teach the role of the Healer and The Professional.to promote behaviors characteristic of both.to evaluate knowledge of both rolesto evaluate behaviors characteristic of both.
26 Four Committees The Healer The Professional Evaluation Post Graduate Education
27 Recommendations Undergraduate A longitudinal program on physicianship throughout 4 years of medical school.Distinct approaches to the Healer and the Professional.Incorporate existing activities including ethics.Create new learning experiences.Revise evaluation system - global rating scale- miniCEXAll students must successfully complete program.
28 Recommendations Postgraduate All residents must master the cognitive base of professionalism.Self reflection must be promoted- small groups- ? portfoliosrevise evaluation system- global rating scale- miniCEX
30 Content Whole class (Flagship) activities at regular intervals Lectures small groupsethics small groupsintroduction to the cadaver small groupsbody donor servicewhite coat ceremony4th year seminars
31 Content unit specific activities (small group) pre-clinical clinical humanism/narrative medicinespiritualitypalliative care medicinecommunity serviceportfolio (self-reflection, self-assessment)
32 Evaluation ALL ATTRIBUTES MUST BE EVALUATED USING AT LEAST ONE METHOD longitudinal - 4 yearsmultiple methodsknowledge - mcq etc. - (do often)global rating scale - UCSF, Maastrictcritical incidentsportfolio? MiniCEXALL ATTRIBUTES MUST BE EVALUATED USING AT LEAST ONE METHOD
33 Faculty Development essential - includes residents knowledge role modelingevaluationRequires resources
34 Resources Assoc/Assist Dean for Physicianship Infrastructure Support - financial and other
35 Summary The role of the Healer and the Professional must be taught. Must start with agreed-upon definitions.The teaching of physicianship should represent a major commitment of the faculty.It should be taught and evaluated in a planned way throughout the curriculum.
36 “The most important problem for the future of professionalism is neither economic nor structural but cultural and ideological. The most important problem is its soul”Freidson, 2001