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December 2000
Volume 64 |
Number 12
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SUPSPECIALTY
NEWS
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| Professionalism:
A New Curricular Challenge
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John D. Emhardt, M.D.,
Immediate Past President
Professionalism. Is it innate? Is it learned
during Boy Scouts or Girl Scouts or sometime during grade school?
Is it something that can be taught to an adult learner? New program
requirements from the Accreditation Council for Graduate Medical
Education (ACGME) www.acgme.org/req_nie/040pr101.asp
will go into effect in January 2001, requiring residency programs
to provide curricula that address the teaching of professionalism.1
This is a daunting task to be sure, but all accredited anesthesiology
residencies will be required to try. In order to create such a
curriculum, we must first establish a definition that includes
aspects which are appropriate to anesthesiology. Then we must
create a curriculum that teaches aspects of professionalism in
anesthesiology. Finally, we must utilize assessment tools to determine
if our students have learned the subject, and we must also determine
if our curriculum itself requires changes.
Professionalism is defined in different
ways by different organizations. The American Board of Internal
Medicine (ABIM) has been ahead of the wave regarding
this new curriculum. ABIM states that "professionalism in
medicine requires the physician to serve the interests of the
patient above his or her self interest. Professionalism aspires
to altruism, accountability, excellence, duty, service, honor,
integrity, and respect for others." This definition, applied
to anesthesiology, is colored by the fact that the anesthesiologist's
encounter with a patient is generally very brief and that the
patient is not conscious for much of the time spent with the anesthesiologist.
Therefore, this definition may not lead to the best judgment regarding
the anesthesiologist's degree of professionalism. Our patient
care is so unique and so focused that the patient is critically
dependent upon us for that brief time. This relationship makes
it crucial that we conduct ourselves in an unquestionably professional
manner in our approach to patient care and that we treat our surgical,
nursing and administrative colleagues with respect and integrity.
It is incumbent upon academic anesthesiologists to conduct themselves
in an exemplary fashion and to ensure that resident anesthesiologists
recognize the importance of professionalism prior to entering
the work force.
| While teaching professionalism may be difficult,
a good role model is a powerful teaching tool. In this depersonalized
digital age of big-business medicine, it is more important
than ever to practice the ideals of professionalism and to
conduct ourselves in a way that can only be admired and respected. |
But how can we teach professionalism to a young resident who
may not already understand the issue? One approach has been developed
by ABIM with a template for a curriculum in its publication, "Project
Professionalism." 2 The booklet
is available from ABIM by calling (215) 446-3562. The Society
for Education in Anesthesia is beginning a similar curriculum that utilizes vignettes developed
for discussion to help illuminate the issues surrounding professionalism.
Small-group discussions using techniques such as role playing
or debates might be effective teaching tools for these concepts.
Next is the issue of assessment. How can we determine if a person
behaves as a professional? The ACGME Outcomes Project, a joint
initiative of ACGME and the American Board of Medical Specialties,
has developed a Toolbox of Assessment Methods© 3
that is available from ACGME. This publication summarizes many
of the assessment methods available for such a project and comments
on the strengths and weaknesses of the various outcomes measuring
tools. Other assessment tools, especially as they pertain to professionalism,
are included in the ABIM's Project Professionalism publication
mentioned earlier in this column.
Probably the most challenging evaluation will be to determine
if our efforts at teaching professionalism are successful. Exit
surveys from outgoing student and resident trainees can shed light
on whether our message has been heard, but it will be very difficult
to determine if the teaching has been effective.
Regardless, we cannot do wrong by trying. We frequently see stories
in the lay press suggesting that the public increasingly views
physicians in a less-than-glowing light. A USA Today headline
from October 11, 2000, reads, "Is Your Doctor Bad? You May
Never Know" and goes on to discuss the National Practitioner
Data Bank. While many of us see the issue as one best addressed
by medical school admissions committees, we must realize that
admissions committees do not assess many of the attributes that
the professional possesses. While teaching professionalism may
be difficult, a good role model is a powerful teaching tool. In
this depersonalized digital age of big-business medicine, it is
more important than ever to practice the ideals of professionalism
and to conduct ourselves in a way that can only be admired and
respected.
References:
1. Program Requirements for Residency Education
in Anesthesiology. Monograph from the Accreditation Council for
Graduate Medical Education. Approved but not currently in effect.
Effective Date 1/2001.
2. Project Professionalism. Monograph published
by the American Board of Internal Medicine. Philadelphia; 1999.
3. Toolbox of Assessment Methods. A Product of
the Joint Initiative. Published by the Accreditation Council for
Graduate Medical Education and American Board of Medical Specialties;
2000.
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John
D. Emhardt, M.D., is Associate Professor, Indiana University
School of Medicine, Indianapolis, Indiana. |
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