Teaching Medical Professionalism

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
List of Contributors......Page 9
ADDRESSING THREATS TO THE INTEGRITY OF THE PRACTICE OF MEDICINE......Page 11
PROFESSIONALISM AS A FRAMEWORK FOR PREPARING PHYSICIANS......Page 12
PROFESSIONALISM ACROSS THE CONTINUUM OF MEDICAL EDUCATION......Page 13
PUTTING THE PRACTICE AT THE CENTER......Page 15
PROFESSIONALISM AS THE INTEGRATION OF APPRENTICESHIP......Page 16
Introduction......Page 19
REFERENCES......Page 22
PART ONE What Is to Be Taught......Page 23
1 The Cognitive Base of Professionalism......Page 25
HISTORICAL ROOTS......Page 26
THE CHALLENGE OF DEFINING PROFESSIONALISM......Page 27
DEFINITIONS......Page 28
THE ATTRIBUTES......Page 30
Changes in the Attributes......Page 32
Changes in the Attributes of the Professional......Page 34
Changes in the Attributes Shared by the Healer and the Professional......Page 35
MEDICINE’S SOCIAL CONTRACT WITH SOCIETY......Page 36
Implications of the Use of the Term ‘‘Social Contract’’......Page 39
SUMMARY......Page 40
REFERENCES......Page 41
PART TWO Theory......Page 47
2 Educational Theory and Strategies for Teaching and Learning Professionalism......Page 49
Why Situated Learning?......Page 50
The Situated Learning Model......Page 51
THE CYCLE OF INSTRUCTIONAL DESIGN......Page 56
Principles of Adult Learning......Page 57
The Experiential Learning Cycle......Page 58
Selecting Educational Strategies and Methods......Page 59
Evaluating Outcome......Page 60
Role Modeling......Page 61
The Use of Case Vignettes and Case Presentations......Page 62
Narrative Medicine......Page 63
Portfolio Learning......Page 64
The Culture of Medicine......Page 65
REFERENCES......Page 66
INTRODUCTION......Page 71
The Rise of Nostalgic Professionalism......Page 73
Deconstructing Nostalgia......Page 75
THE MEDICAL SCHOOL AS A SITE OF OCCUPATIONAL SOCIALIZATION......Page 76
Introduction......Page 77
Socialization Theory......Page 78
PROFESSIONALISM AS A FORM OF SOCIAL CONTROL......Page 80
Medical Education as Resocialization......Page 81
CONCLUSIONS......Page 82
REFERENCES......Page 85
PART THREE Principles......Page 89
4 Principles for Designing a Program for the Teaching and Learning of Professionalism at the Undergraduate Level......Page 91
PRINCIPLES......Page 92
Allocation of Responsibility......Page 93
The Environment......Page 94
The Cognitive Base......Page 95
Experiential Learning and Self-Reflection......Page 96
Role Modeling......Page 98
Faculty Development......Page 100
Continuity......Page 101
Evaluation......Page 102
An Incremental Approach......Page 103
REFERENCES......Page 104
5 Resident Formation – A Journey to Authenticity: Designing a Residency Program That Educes Professionalism......Page 111
THE CONTEXT OF THE WORK......Page 115
Design Feature 1: Work with rather than against Human Nature......Page 117
Design Feature 2: Enable Reflective Practice......Page 118
Design Feature 4: Validating and Mining the Resident’s Feelings......Page 119
Design Feature 6: Getting Discretion and Discipline Right......Page 120
Design Feature 8: Social Justice......Page 121
Design Feature 9: Linking Evaluations to System Improvement......Page 122
CONCLUSIONS......Page 123
REFERENCES......Page 124
6 Supporting Teaching and Learning of Professionalism – Changing the Educational Environment and Students’ ‘‘Navigational Skills\"......Page 126
REFERENCES......Page 139
Assessment’s Role......Page 142
Assessment Methods......Page 143
Specific Approaches to Assessing Faculty’s Professionalism......Page 148
Assessment Issues and Recommendations......Page 149
Identifying the Lapse......Page 150
The Remediation Process......Page 151
Techniques for Remediation......Page 152
Likelihood of Success......Page 153
An Example of a Remediation Plan......Page 154
EVALUATION OF THE ENVIRONMENT......Page 156
REFERENCES......Page 158
8 Developing Professionalism across the Generations......Page 168
COMMON GROUND......Page 169
GENERATIONAL DIFFERENCES......Page 171
SOCIAL CHANGE......Page 172
CAREER STAGE......Page 173
TEACHING STRATEGIES......Page 174
TEACHING STRATEGIES FOR MEDICAL STUDENTS......Page 175
STRATEGIES FOR OLDER PHYSICIANS......Page 178
REFERENCES......Page 179
9 Faculty Development for Teaching and Learning Professionalism......Page 183
WHY FACULTY DEVELOPMENT IS NEEDED......Page 184
GENERAL GUIDELINES FOR DESIGNING A FACULTY DEVELOPMENT PROGRAM......Page 185
Target Diverse Stakeholders......Page 186
Workshop, Seminars, and Short Courses......Page 187
Web-Based Learning......Page 188
Incorporate Principles of Adult Learning and Instructional Design......Page 189
Promote Buy-In and Market Effectively......Page 190
PRINCIPLES FOR DESIGNING FACULTY DEVELOPMENT PROGRAMS TO PROMOTE THE TEACHING AND LEARNING OF PROFESSIONALISM......Page 191
Start with a Focus on Teaching......Page 192
Faculty Development to Promote Curriculum Development and Organizational Change......Page 193
Process......Page 194
‘‘Think Tank’’ on Teaching Professionalism......Page 196
Faculty-Wide Workshop on Teaching Professionalism......Page 197
Faculty-wide Workshop on Evaluating the Physician as Healer and Professional......Page 198
CONCLUSIONS......Page 199
REFERENCES......Page 200
INTRODUCTION......Page 203
Patients’ Ideas of a Good Doctor......Page 205
Public Expectations of Professional Regulation......Page 206
Evolving Ideas about Professionalism and Professional Regulation......Page 208
New Professionalism, New Professional Regulation......Page 210
Professional Standards......Page 211
New Professionalism, New Learning, and Teaching......Page 213
REFERENCES......Page 215
INTRODUCTION: FRAMING THE ISSUE......Page 218
The Public’s Stake in Medical Professionalism......Page 219
EDUCATING THE PUBLIC ABOUT PROFESSIONALISM......Page 220
IN PREPARATION FOR EDUCATING THE PUBLIC......Page 221
Harnessing the Mini-Med School......Page 222
Engaging Hospital-Based Programs......Page 223
Enlisting Professional Organizations......Page 224
REFERENCES......Page 225
PART FOUR Practice: Case Studies in Teaching Professionalism across the Continuum......Page 227
INTRODUCTION......Page 229
UWSOM STRUCTURE......Page 230
Preclinical Curriculum......Page 232
ICM I......Page 233
ICM II......Page 235
Professionalism Working Group......Page 236
Clinical Curriculum......Page 238
Other Components......Page 239
REFERENCES......Page 241
BACKGROUND......Page 243
THE CONTEXT......Page 245
OPPORTUNITIES FOR LEARNING PROFESSIONALISM......Page 250
ASSESSING PROFESSIONALISM AND FITNESS FOR PRACTICE......Page 253
CURRICULUM EVALUATION AND IMPLEMENTATION ISSUES FOR PROMOTING PROFESSIONALISM IN A PROBLEM-BASED CURRICULUM......Page 255
LESSONS LEARNED......Page 258
REFERENCES......Page 259
THE CONTEXT......Page 264
TRANSLATING CONCEPTS INTO EDUCATIONAL PRACTICE: A FRAMEWORK......Page 265
Learning the Cognitive Base......Page 267
Academic Half-Day on Professionalism......Page 268
Other Large-Group Learning Activities to Teach the Cognitive Base......Page 270
Developing Professional Attitudes and Fostering Professional Behaviors: Transferring Learning into Practice......Page 271
The Learning Environment......Page 272
Evaluation......Page 274
Faculty Development......Page 276
LESSONS LEARNED......Page 277
REFERENCES......Page 279
The Case for Continuing Professional Development in Professionalism......Page 281
Addressing the Gap......Page 283
The Audience and Their Clinical World......Page 284
The Adult Learner......Page 285
What Do Learners Need or Want?......Page 286
Subjective Needs Assessment......Page 287
DECIDING ON THE CONTENT AND FORMAT: INCORPORATING PROFESSIONALISM INTO CPD......Page 288
Increasing Relevance: The Clinical Scenario......Page 289
Increasing Engagement......Page 290
Faculty Development......Page 291
Competence......Page 292
REFERENCES......Page 293
SOCIAL SCIENCES LITERATURE......Page 297
SELECTED DEFINITIONS FROM THE MEDICAL LITERATURE......Page 299
MEDICAL ORGANIZATIONS......Page 300
ATTRIBUTES OF BOTH THE HEALER AND THE PROFESSIONAL......Page 303
ATTRIBUTES OF THE PROFESSIONAL......Page 304
FOR UNDERGRADUATE CLINICAL MEDICAL STUDENTS......Page 305
Case #1......Page 306
Case #3......Page 307
Case #5......Page 308
APPENDIX D A Matrix for ‘‘Matching’’ Teaching Methods to Attributes......Page 309
APPENDIX E Sample Grid for Use with Discussion of Vignettes......Page 310
APPENDIX F Sample Questions to Guide Discussion about the Social Contract......Page 312
APPENDIX G Professionalism Program for Residents: Suggested Outline for Small Group Facilitators......Page 313
APPENDIX H Sample Evaluation Form for Residents’ Half-Day Program on Professionalism......Page 315
Index......Page 317