Assessment of professionalismEthics in professional practice

Professor Rona PateyUniversity of Aberdeen

r.patey@abdn.ac.uk

Definition of professionalism

Numerous definitions……..but uncertainty remains

‘Medical professionalism signifies a set of values, behaviours and relationships that underpins the trust the public has in doctors with doctors being committed to integrity, compassion, altruism, continuous improvement, excellence & teamwork’

Royal College of Physicians 2005

Supporting the development of professionalism

• Curriculum design• Student selection• Teaching & learning methods• Role modeling• Assessment methods

Passi et al Medical Education 2010

Why assess professionalism?

• Post-grad disciplinary action strongly associated with prior ‘unprofessional behaviours’ as an undergraduate– Severe irresponsibility– Severely limited capacity for self improvement

Papadakis et al 04 & 05

• Requirement for students to demonstrate professionalism by regulators

• Most complaints about conduct not competence

• Present behaviour can predict future actions

• Doesn’t osmose

• All clinicians vulnerable to lapses in professional behaviour & can benefit from explicit attention to this domain

• Evidence that there may be a deterioration in professional attitudes from idealism to cynicism

Assessment of professionalism

• Many instruments described

• No single instrument for all aspects of professionalism

• Multidimensional approach

• Aim to track attitudes throughout curriculum

• Workplace based assessment desirable with multiple assessors in multiple clinical settings

Methods of assessing professionalism

• Peer assessment• Direct observation• Patient evaluations• OSCE• Standardised patient

assessments• Student evaluation• Reflective writing

• Self assessment• Educational portfolios• Teamwork exercises• P-MEX• Attendance / work

records• Video analysis• Situational judgement

test

Ethics in professional practice

• Two points of view on teaching ethics– Means of creating virtuous clinicians– Means of providing clinicians with the skill set to

analyse and resolve ethical dilemmas

• Work required to delineate core content, core processes, core skills

UoA Ethics teaching

• Professional & ethical code – Introduced in Year 1 &

signed annually

• Reflective writing• Whole class and small

group discussion• Clinical practise

UoA Ethics: Y1

• 4 principles– Beneficence– Non-maleficence– Respect for autonomy– Justice

• Highlight topics of particular relevance for the students:– Non-judgmental approach– Not imposing personal

views & respecting patient views

– Confidentiality– Not exceeding your

competency– Fitness to practise

UoA Ethics Y2

UoA Y3, Y4 & Y5

• Clinical experience• Professional practice blocks ( 3 days Y3 / 2 x 2

wks Y5)– Ethics case scenarios– Medicolegal sessions e.g. mock Fatal accident

inquiry

Role models & the learning environment

• Important in:– professional character formation– to impart values of the profession

• Three characteristics of good role models– Clinical competence– Teaching skills– Personal qualities

University of Dundee poster for clinical areas

Our context

• Students changing cultural contexts– Social and system differences

• Transfer of information on student professionalism– What?– How?

Questions / discussion