1. Professionalism in inMedicineProfessionalism Medicine By Dr. Mohammed O. Al-Rukban Associate Professor Family Medicine Consultant

2. Do You Still Remember A Role Model Who Influenced Your Training? If Yes? Mention Some of Their Qualities and Attributes.

3. What is professionalism? How can we Implement it in the Curriculum? How can we Teach it? How can we Assess it? Professionalism

4. What does professionalism means to you? Take a few minutes and write down your thoughts … as a definition or description.

5. What is Professionalism? It is not easy to define a profession, but it is likely to have all or Some of the following characteristics:It is not easy to define a profession, but it is likely to have all or Some of the following characteristics: –It is a vocation or calling that implies service to others –It has a distinctive knowledge base which is kept up to date –It determines its own standards and sets its own examinations –It has a special relationship with those whom it serves e.g. patients, students…. –It has particular ethical principles

6. Professionalism is a term which embodies numerous qualities of physicians as public servants.Professionalism is a term which embodies numerous qualities of physicians as public servants. It has been described by The American Board of Internal Medicine (ABIM) as:It has been described by The American Board of Internal Medicine (ABIM) as: “Constituting those attitudes and behaviors that serve to maintain others interest above physician Self-interest” “Constituting those attitudes and behaviors that serve to maintain others interest above physician Self-interest”

7. الطبيب المسلم مهنيٌ بطبعه ” ويؤثرون على أنفسهم ولو كان بهم خصاصة “ ” ويؤثرون على أنفسهم ولو كان بهم خصاصة “ ” إن الله يحب من العامل إذا عمل أن يتقن “ ” إن الله يحب من العامل إذا عمل أن يتقن “ ” إذا ذبحتم فأحسنوا الذبحة.........“ ” إذا ذبحتم فأحسنوا الذبحة.........“ ” لا يؤمن أحدكم حتى يحب لأخيه ما يحب لنفسه..“ ” لا يؤمن أحدكم حتى يحب لأخيه ما يحب لنفسه..“

8. 'Project Professionalism' (ABIM, 2001) Developed the Physician Charter and identified six key elements of professionalism: 1- Altruism (giving priority to patient interests rather than self-interests); 2- Accountability (being answerable to patients, society and profession); 3- Excellence (conscientious effort to perform beyond ordinary expectation, and commitment to life-long learning);

9. 'Project Professionalism' (ABIM, 2001) 4- Duty (free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care); 5- Honor and integrity (being fair, truthful, straightforward, and keeping to one's work); 6- Respect for other (respect for patients and families, colleagues, other healthcare professionals and students and trainees).

10. The concept of professionalism includes the following values:  Honesty  Trust  Service  Commitment  Communication  Accountability  Life-long learning

11. Defining Professionalism What specific behaviors are unprofessional in your settings?

12. Examples of Unprofessional Behaviors Classroom Setting-Students/Trainee Arriving for class late and/or leaving early Being unprepared for group sessions Not completing assigned tasks Disrupting class sessions Failing to attend scheduled class sessions Cheating on an exam

13. Examples of Unprofessional Behaviors Classroom Setting-Students/Trainees Using Mobile Phone during classUsing Mobile Phone during class Chatting during classChatting during class Focusing on the test vs. learningFocusing on the test vs. learning Prejudging content in advancePrejudging content in advance Intolerance of the opinions of othersIntolerance of the opinions of others

14. Examples of Unprofessional Behaviors Classroom Setting-Faculty Plagiarism Judgmental attitude or favoritism Coming late Sloppy handouts and syllabi Abusive behavior Using Mobile Phone during class

15. Examples of Unprofessional Behaviors: Clinical Setting-Students Dressing inappropriately Avoiding work and/or responsibilities Exhibiting little empathy for patients Demonstrating lack of sensitivity to patients’ cultural backgrounds Not protecting patient confidentiality

16. Examples of Unprofessional Behaviors: Clinical Setting: Faculty Showing favoritismShowing favoritism Failing to attend scheduled sessionsFailing to attend scheduled sessions Using inappropriate language or behaviorUsing inappropriate language or behavior Asking learners to perform personal tasks, for example, picking up laundryAsking learners to perform personal tasks, for example, picking up laundry

17. Common Examples Marketing for a new drug?Marketing for a new drug? Conflicts between government vs private commitments.Conflicts between government vs private commitments.

18. Signs and Symptoms The work of Project Professionalism (ABIM, 2001) describes unprofessional behaviour in terms of seven broad categories of 'signs and symptoms'. The work of Project Professionalism (ABIM, 2001) describes unprofessional behaviour in terms of seven broad categories of 'signs and symptoms'. 1- Abuse of power (abuse while interacting with patients and colleagues; bias and sexual harassment; and breach of confidentiality); 2- Arrogance (offensive display of superiority and self-importance); 3- Greed (when money becomes the driving force);

19. Signs and Symptoms 4- Misrepresentation (lying, which is consciously failing to tell the truth; and fraud, which is conscious misrepresentation of material fact with the intent to mislead); 5- Impairment (any disability that may prevent the physician from discharging his/her duties); 6- Lack of conscientiousness (failure to fulfill responsibilities); 7- Conflicts in interests (self-promotion/ advertising or unethical collaboration with industry; acceptance of gifts; and misuse of services – overcharging, inappropriate treatment or prolonging contact with patients).

20. How professionalism can be implemented?

21. Professionalism and Curriculum Design Performance Of Task

22. Patient management Knowledge Practical procedures Patient investigation Clinical skills Health promotion and Disease prevention Decision making skills and clinical reasoning and judgment Basic, Social and clinical sciences Personal Development & Lifelong Learning Role of the doctor within the health service and community Performance Of task

23. Professionalism Role of the doctor within the health service –Understanding of the health care system –Understanding of clinical responsibilities –Appreciation of doctor as researcher –Appreciation of doctor as mentor or teacher –Appreciation of doctor as manager including quality control –Team working Personal Development –Lifelong Learner –Self awareness –Self confidence –Self regulation Self care Self control Personal time management – Motivation Achievement drive Commitment initiative –Career choice

24. How professionalism can be taught?

25. Professionalism in the Curriculum There is strong support for professionalism to be considered as: There is strong support for professionalism to be considered as: A learning outcome (ACGME, 2007; Harden et al., 1999; CanMeds 2000), A learning outcome (ACGME, 2007; Harden et al., 1999; CanMeds 2000), A skill set (Emanuel, 2004) or A skill set (Emanuel, 2004) or A competence (Leach, 2004; Hester and Kovach, 2004; Fryer-Edwards & Baernstein, 2004). A competence (Leach, 2004; Hester and Kovach, 2004; Fryer-Edwards & Baernstein, 2004). Many medical schools have their integrated curriculum content about professionalism within their curriculum, added courses on professionalism in the first two years, or have introduced behaviour into the clinical clerkships Many medical schools have their integrated curriculum content about professionalism within their curriculum, added courses on professionalism in the first two years, or have introduced behaviour into the clinical clerkships (Whitcomb, 2002). (Whitcomb, 2002).

26. Curriculum content relating to professionalism The key attributes of a professional: The key attributes of a professional: ethics, decision making/moral reasoning, humanism, multiculturalism, empathy values, truth telling, care for the vulnerable, trust, attitudes and communication, confidentiality of patient data, contact with patients, emotional intelligence, mental health, and self- assessment (using reflective practice). ethics, decision making/moral reasoning, humanism, multiculturalism, empathy values, truth telling, care for the vulnerable, trust, attitudes and communication, confidentiality of patient data, contact with patients, emotional intelligence, mental health, and self- assessment (using reflective practice). systematic review, Veloski et al. (2005) These should be integrated into the component courses of the curriculum rather than taught as a stand alone course. These should be integrated into the component courses of the curriculum rather than taught as a stand alone course.

29. How can We Teach Professionalism? Role Modeling Bed Side Teaching Simulated Patients Small Group Discussions

30. Do that.. & Don’t do that

31. Follow Me

32. How can professionalism be Assessed?

33. Miller’s Triangle Knows Shows how Knows how Does Professionalism Written, Oral or Computer based assessment Performance or hands on assessment Portfolios

34. Use Suitable Assessment Tools Multiple choice questions-Knows?? Faculty evaluations-Knows, knows how, shows how?? Clinical vignettes & OSCE & OSPE- Knows, knows how?? Standardized patients-Knows how, shows how??

35. Assessment of Professionalism Structured, standardized rating scales are the most effective measure. Structured, standardized rating scales are the most effective measure. The Outcome Project (ACGME, 2007) and Project Professionalism (ABIM, 2001) Rating scales have been used in two contexts: to assess performance in the workplace, through direct observation (Cohen, 2001) ; and to assess how the students respond to case vignettes (ACGME, 2007). Rating scales have been used in two contexts: to assess performance in the workplace, through direct observation (Cohen, 2001) ; and to assess how the students respond to case vignettes (ACGME, 2007).

36. Assessment of Professionalism The PMEX (Professionalism Mini Evaluation Exercise) of the ABIM (Norchi et al., 2003) and EPRO-GP (van de Camp et al., 2005) are examples of rating scales for assessing professionalism in the workplace. The PMEX (Professionalism Mini Evaluation Exercise) of the ABIM (Norchi et al., 2003) and EPRO-GP (van de Camp et al., 2005) are examples of rating scales for assessing professionalism in the workplace. For assessing professionalism using case vignettes, both ACGME (ACGME, 2007) and ABIM (ABIM, 2001) have compiled compendia of case vignettes. For assessing professionalism using case vignettes, both ACGME (ACGME, 2007) and ABIM (ABIM, 2001) have compiled compendia of case vignettes.

37. Assessment of Professionalism Rating scales have been used to assess professionalism in a variety of settings. Rating scales have been used to assess professionalism in a variety of settings. ACGME, for example, uses rating scales in: self-assessment; direct observation by faculty; ethics OSCE stations; peer- assessment (Hafferty, 2002); and 360 degree assessment (Kirk, 2007). ACGME, for example, uses rating scales in: self-assessment; direct observation by faculty; ethics OSCE stations; peer- assessment (Hafferty, 2002); and 360 degree assessment (Kirk, 2007).

38. Assessment of Professionalism All the above rating scales have demonstrated validity and feasibility. All the above rating scales have demonstrated validity and feasibility. (Holmboe et al., 2003; van de Camp et al., 2005) Reliability, however, in many of these examples is not yet available. Reliability, however, in many of these examples is not yet available.

39. How can We Assess Professionalism? Peer Evaluation-DoesPeer Evaluation-Does Patient Surveys-DoesPatient Surveys-Does Staff evaluations-DoesStaff evaluations-Does Professionalism Portfolio (self evaluation)- DoesProfessionalism Portfolio (self evaluation)- Does 360 degree evaluation-Does360 degree evaluation-Does

40. Take Home Messages Professionalism should be part of the formal curriculumProfessionalism should be part of the formal curriculum Professionalism must be taught and assessedProfessionalism must be taught and assessed Professionalism must be relevant to the society it servesProfessionalism must be relevant to the society it serves

41. Final Word “There is a tendency to underemphasize the personal characteristics…, because they are harder to measure, and to overemphasize the more easily measured indices of academic achievement” “There is a tendency to underemphasize the personal characteristics…, because they are harder to measure, and to overemphasize the more easily measured indices of academic achievement” Cohen (2002) Cohen (2002)