Download presentation
Presentation is loading. Please wait.
1
Development of Professionalism and Fitness to Practice
Trudie Roberts Kathy Boursicot
2
Workshop format Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary
3
Professionalism in the 21st Century
4
The Past A. Bierce from The Devil’s Dictionary
“The past is that part of eternity with some small fraction of which we have a slight and regrettable acquaintance” A. Bierce from The Devil’s Dictionary
5
The past – ‘a golden age’
Patients were passive and grateful Regulation of doctors was controlled by doctors themselves Public accountability was negligible Social prestige was high
6
“A place of multiple realities”
The Present “A place of multiple realities” D.J. Cottrell 2000
8
The Present A time of unprecedented change No return to the golden age
A questioning society Professions including medicine have lost status Professionalism is the key to public trust The future will depend in part on how medicine responds
9
Present Challenges The changing healthcare system
Issues of professional competence Quality assurance
10
The Changing Healthcare System
The changing focus of patient treatment The changing focus of illness The changes in society* The change in public expectations*
11
Changing value systems
Libertarian Communitarian Utilitarian
12
The Changing Composition of Societies
Population movement Globalisation and migration Development of cultural diversity within geographical regions
13
The Change in Public Expectations
Consumer society Empowerment Choice Informed public Increased access to information media
14
Competing models Professionalism Consumerism Regulation Management
Accountability
15
Changing world of work Unique point in time – 4 distinct groups of workers Duxbury 2002
16
Types Traditionalists Baby boomers Generation X Generation Y
17
Pre 1946 Traditionalists Totally committed to the ‘company’
Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty
18
1947- 1972 Baby Boomers Workaholics Accept stress as part of the job
Used to belt tightening and sacrifice Work predicated on delayed gratification Value titles and status symbols
19
1968 – 1980 Generation X Place more importance on career than personal life Mistrustful and suspicious of employers Products of downsizing and cost cutting Usually had experience of many jobs Not committed to a particular company Want immediate gratification
20
1980 – 1995 Generation Y Want a balance of work and personal life
Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expanding job market and shrinking work force Expect and get immediate reward
21
How do each of these groups interpret professionalism?
22
Can professionalism survive?
24
The Future “The future is that period of time in which our affairs prosper, our friends are true, and our happiness is assured” A. Bierce from The Devil’s Dictionary
25
The Social Contract hinges on professionalism
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.
26
Workshop format Defining professionalism
Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary
28
Definitions (1) UK’s GMC Duties of a Doctor Good Medical Practice
CanMEDS Medical expert, communicator, collaborator, manager, health advocate, scholar, professional ABIM/ACP/EFIM – “A Physician Charter” Patient welfare Patient autonomy Social justice
29
Definitions (2) Swick Cruess & Cruess Cosgrove Need for a definition
9 professional behaviours Cruess & Cruess Physician as Healer / as Professional Damaged social contract Cosgrove Professionalism – state not trait
30
Definitions (3) Calman “The Profession of Medicine”
High ethical standards CPD, change and improvement, R&D Teamwork Health as well as illness Concern with clinical effectiveness & outcomes Ability to communicate
31
What do we mean by Professionalism?
Six Domains: Ethical practice Reflection / self awareness Responsibility for actions Respect for patients Working with others Social responsibility
32
Workshop format How to teach professionalism?
Setting the scene – Professionalism in the 21st centuary Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary
34
PERIOD OF PROTO-PROFESSIONALISM
NEW MEDICAL STUDENT PERIOD OF PROTO-PROFESSIONALISM MATURE PROF- ESSIONAL MATURITY PHRONESIS EXPERIENCE SDL NAIVE PBL +ve ROLE MODELS Y Y Y Y Y Q Reg PGT NAÏVE N O
35
PERIOD OF PROTO-PROFESSIONALISM
NEW MEDICAL STUDENT MATURE PROF- ESSIONAL PERIOD OF PROTO-PROFESSIONALISM IDEALISTIC BAD EXPERIENCES -ve ROLE MODELS FATIGUE CYNICAL POLITICS ADDICTIVE BEHAVIOURS Y Y Y Y Y Q Reg PGT NAÏVE N O
36
How Can Professionalism Be Taught?
Role Models Didactics on History of Medicine, Self-Regulation and Public Policy Small Group Discussions Grand Rounds Named Lectures Teaching ward rounds Clinical Vignettes Reflective Exercises Self-Assessment/Narratives
37
ACQUISITION DECAY PERIOD OF PROTO-PROFESSIONALISM
NEW MEDI- CAL STUDENT MATURE PROFESSIONAL ACQUISITION DECAY NAÏVE N O
38
Workshop format Setting the scene – Professionalism in the 21st century Defining professionalism How to teach professionalism? How to assess professionalism and ensure fitness to practice? Summary
40
Model of competence Does Shows how Knows how Knows Behaviour~
skills/attitudes Does Professional authenticity Shows how Knows how Cognition~ knowledge Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.
41
Climbing the pyramid...... Does Does Shows how Shows how Knows how
Performance assessment in vivo: Work based assessment, Video, Audits Does Shows how Performance assessment in vitro: OSCE, SP-based test….. Shows how Knows how (Clinical) Context based tests: EMQ, essay type, oral….. Knows how Knows Factual tests: MCQ, essay type, oral….. Knows
42
New skills emphasized learning how to learn self-appraisal leadership
team skills metacognition professionalism reflectiveness/reflexiveness…….
43
Extending the pyramid Knows Shows how Knows how Does “Meta” skills
44
How to assess “meta-skills”?
Self assessment Peer assessment Co-assessment (combined self, peer, teacher assessment) Patient ratings Log book/diary Structured evaluations (mini cex etc) Portfolio assessment……..
45
How to assess “meta-skills”?
Basic method: Information gathering relying more on descriptive and qualitative judgemental information
46
Workshop format Setting the scene – Professionalism in the 21st centuary Defining professionalism How to teach professionalism How to assess professionalism and ensure fitness to practice Summary
47
Thank you
Similar presentations
