1. PROFESSIONALISM EDUCATION: POSSIBLE COMPETENCIES Barbara Barzansky, PhD, MHPE LCME Co-Secretary APHC Conference May 3, 2013

2. SESSION GOALS  Describe LCME expectations related to teaching and assessing professionalism  Consider potential competencies based on the new ACGME “Milestones”  Discuss implementation of professionalism competencies

3. QUESTION FOR CONSIDERATION How does a medical school help students become “professional”/develop a professional identity?

4. LCME ACCREDITATION STANDARDS: THE LEARNING ENVIRONMENT MS-31-A. A medical education program must ensure that its learning environment promotes the development of explicit and appropriate professional attributes in its medical students (i.e., attitudes, behaviors, and values)

5. EXPECTATIONS OF THE LCME LEARNING ENVIRONMENT STANDARD  Define professional attributes  Teach to and assess the attainment of these attributes  Assess the learning environment to identify negative influences on the development of the attributes  Work with clinical partners to mitigate negative influences

6. LCME ACCREDITATION STANDARDS: ETHICS ED-23. A medical education program must include instruction in medical ethics and human values and require its medical students to exhibit scrupulous ethical principles in caring for patients and in relating to patients’ families and to others involved in patient care.

7. QUESTIONS FOR CONSIDERATION What should students learn about professionalism? About ethics? How should their competency develop in these areas?

8. THE ACGME “MILESTONES” AS A FRAMEWORK The ACGME Milestones “add a timeline and benchmarks to resident progression towards independent practice.” 1 They are behavioral and grounded in the six ACGME competency areas. 1. Source: Journal of Graduate Medical Education, March 2013 supplement

9. PROFESSIONALISM MILESTONE AREAS The following summarizes the areas covered in professionalism milestones in four specialty areas: emergency medicine, internal medicine, orthopedic surgery, and pediatrics. The number of professionalism milestones in those specialties ranged from 2 to 5. There was considerable overlap across the specialties.

10. RESPECTFUL INTERACTIONS  Respectful interactions with patients, caregivers, members of the health care team (including interprofessional interactions)  Cultural competence/responsiveness to diverse patient populations  Respect for each patient’s unique characteristics

11. ACCOUNTABILITY/RESPONSIBILITY  Sense of duty to patients, society, the profession, and self  Follow through on tasks/reliability  Accepts responsibility to maintain emotional, physical, and mental health

12. ETHICAL BEHAVIOR  Observation of professional boundaries  Demonstration of professional values/compassion, integrity, altruism, humanism  Adherence to relevant ethical principles

13. SELF-AWARENESS  Awareness of own knowledge, skills  Engages in knowledge-seeking behaviors  Recognizes that ambiguity is part of clinical care/utilizes resources to deal with uncertainty

14. CREATING COMPETENCIES FOR MEDICAL STUDENTS Medical schools should provide the grounding in knowledge, skills, and behaviors related to professionalism. These will form the basis of what is built upon in GME. How should schools translate the professionalism Milestone areas into medical school competencies/objectives?

15. CREATING COMPETENCIES (con’t) THE GOAL: To enhance the continuum between medical school and residency training related to professionalism knowledge, skills, and behaviors THE CHALLENGE: How to encourage consistency among schools in: - expected outcomes/levels of performance - assessment methods (assurance of validity and reliability)

16. CREATING COMPETENCIES (con’t) THE GOOD NEWS: Medical schools already are covering (at least some) areas in the Milestones related to professionalism. Medical schools already are assessing professional behaviors

17. FOR EXAMPLE: METHODS USED TO ASSESS MEDICAL STUDENTS’ PROFESSIONAL BEHAVIORS Method# of Schools* OSCE with professionalism stations 99 Observation by clinical faculty in clerkships 134 Observation by residents 126 Observation during preclinical small gp sessions 129 Observation during laboratory sessions 118 Comments from other health personnel 79 Comments from patients 55 * 2011-2012 data; N = 134

18. FOR EXAMPLE: DOES PROFESSIONALISM “COUNT” Is professional behavior an explicit component of medical students’ grades in: # of Schools* One of more basic science courses 98 Course that teaches basic clinical skills 126 One or more required clinical clerkships 132 * 2011-2012 data; N = 134

19. WHAT DO STUDENTS THINK? Percent of 2012 4 th year students who reported 1 that their instruction in the following areas was: Inadequate Appropriate Excessive Ethical decision-making 6.5 85.1 8.5 Culturally- appropriate care 11.4 83.1 5.5 Professionalism 1.8 82.8 15.4 Biomedical ethics 8.9 87.1 4.0 1. AAMC Medical School Graduation Questionnaire, 2012 (~12,500)

20. THE NEED  Common set of competencies for professionalism with common behaviorally-based definitions (e.g., what does EMPATHY mean for a third-year medical student)  Defined/agreed-upon professionalism outcomes for medical school graduation