Teaching, Promoting and Assessing Professionalism: Can The Physician Charter Help?

Linda L. Blank Penn State College of Medicine July 21, 2003

The Physician Charter serves as a framework for contemplating contemporary Professionalism

Do These General Perceptions Resonate With You?

• We live in a time of unprecedented change • We live in a questioning society • Professions and medicine have lost status • We will not return to the golden period • The future will depend in part on how medicine responds • Professionalism is the key to public trust

Physician Charter: What Difference Can It Make?

•

PROFESSION

Re-emphasizes the central nature of Professional Conduct in training and practice •

GENERAL PUBLIC

Contributes to re-establishing trust between Physicians and Patients

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.

COMPONENTS OF PROFESSIONALISM Individual

Competence Commitment Altruism Integrity and honesty Morality and ethics Autonomy Teamwork

Knowledge Service Collective

Develop standards Education Foster research Ensure integrity of knowledge base Proper use of resources Ensure access Promote social justice Self regulation Responsibility to society

Accountability

Responsibility to the profession Self regulation set and maintain standards discipline Economic and political Advise public Drs. Richard and Sylvia Cruess

DEFINING 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.” Drs. Richard and Sylvia Cruess Derived from

Oxford English Dictionary

and literature on Professionalism

Attributes

Physician Healer Professional Caring and compassion Insight Openness Respect for the healing function Respect patient dignity and autonomy Presence Competence Commitment Altruism Integrity and honesty Morality and ethics Self-regulation Responsibility to society Responsibility to the profession Team work Autonomy Drs. Richard and Sylvia Cruess

The Charter’s Principles

Primacy of Patient Welfare Patient Autonomy Social Justice

Attributes • • • Commitment Altruism Presence • • • • Respect patient dignity and autonomy Commitment Caring and compassion Openness • • Responsibility to society Respect patient dignity and autonomy

Charter’s Commitments Professional Competence Honesty with Patients Attributes • • • Competence Self-regulation Teamwork • • • • Morality and ethics Integrity and honesty Respect for the healing function Respect for patient dignity and autonomy

Charter’s Commitments Patient Confidentiality Maintaining Appropriate Relations with Patients Attributes • • • Commitment Morality and ethics Respect patient dignity and autonomy • • • Morality and ethics Responsibility to the profession Insight

Charter’s Commitments Improving Quality of Care Improving Access to Care Attributes • • • Self-regulation Responsibility to society Responsibility to the profession • Responsibility to society

Charter’s Commitments Just Distribution of Finite Resources Scientific Knowledge Attributes • • • • Responsibility to society Responsibility to profession Self-regulation Autonomy • • Competence Self-regulation

Charter’s Commitments Managing Conflicts of Interest Attributes • • • Integrity and honesty Morality and ethics Altruism Professional Responsibilities • • Responsibility to the profession Self-regulation

A Notable Quotable on Assessment

“That which we can measure, we can more readily improve.” David Leach, MD Executive Director, ACGME

How Can Professionalism Be Evaluated?

I.

II.

III.

IV.

V.

Examinations Program Director Ratings Structured Evaluations (Mini-CEX) Peer and Patient Ratings Professional Portfolios

I.

Examinations

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Impaired physicians (duty to report)

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Spouse/elder abuse

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Respect (patient’s right to refuse treatment)

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Abuse of power (inappropriate physician patient relationships)

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Confidentiality (pregnancy/HIV)

II. Program Director Ratings Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice Overall Clinical Competence

III.

Structured Evaluation: The Mini-CEX

IV. Patient and Peer Assessment

Select raters: Distribute surveys; Use interactive voice response system to complete

Report 10 Peers 25 Patients Self-Assessment Quality Improvement Plan

V.

Professional Portfolios A Promising Strategy to:

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Show evidence of competence

•

Promote self-reflection

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Stimulate self-directed learning

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Foster a healthy professional lifestyle that leads to achieving long-term career goals

How Can Professionalism Be Taught?

• • • • • • • • •

Role Models, Role Models, Role Models Didactics on History of Medicine, Self Regulation and Public Policy Small Group Discussions Grand Rounds Named Lectures Morning Report, Noon Conferences Clinical Vignettes Reflective Exercises Self-Assessment/Narratives

How Can Professionalism Be Rewarded?

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Feeling Good About a Job Well Done

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Performance Reviews

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Named Lectureships

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Local and National Recognition Awards

Develop awards to honor those at Penn State College of Medicine who demonstrate the principles and commitments of the Charter on Medical Professionalism.