1. Teaching Medical Professionalism
Cherdsak Iramaneerat
Department of Surgery
Faculty of Medicine Siriraj Hospital
Mahidol University

2. Medical Professionalism
the mastery of a complex body of knowledge, with an ethical commitment to integrity, morality and altruism. These skills and attitudes are used in the service of others as the basis of a social contract between the medical profession and the community. Society, in return, grants the privilege of self-regulation and autonomy in practice
Ethics Committee of the New Zealand Medical Association

3. Medical Professionalism
Key components: 6 domains
3 Intrinsic attributes
Ethical practice
Reflection and self-awareness
Responsibility and accountability
3 extrinsic (cooperative) attributes
Respect for patients
Teamwork
Social responsibility
Hilton SR, Slotnick HB. Proto-professionalism: how professionalisation occurs across the continuum of medical education, Medical Education (2005) 39: 58-65

4. Some Challenges in Teaching Medical Professionalism
No clear concepts: not clear about what to teach
Students can learn by observation: These things do not need to be said
These things are fixed trait. It is too late to change their values and characters now.
This is not my job. It is somebody’s job
I am not good enough
I don’t know how to teach

5. Clear Concepts Fundamental principles of medical professionalism
ABIM, ACP-ASIM, EFIM. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine 2002: 136; 243 – 6.
Fundamental principles of medical professionalism
Principle of primacy of patient welfare
Principle of patient autonomy
Principle of social justice

6. Clear Concepts
Goldie J. Review of ethics curricula in undergraduate medical education. Medical Education 2000; 34: 108 – 19.
De Camp conference recommendation on medical ethics core curriculum
Ability to identify the moral aspects of medical practice
Ability to obtain a valid consent or refusal of treatment
Knowledge of how to proceed if a patient is incompetent, refuses treatment
Ability to decide when to withhold information, breach confidentiality
Moral aspects of caring for poor prognosis patients

7. Needs for Teaching?
Eckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching “Generation Y”. Journal of Graduate Medical Education, 2011: 458 – 61.
Generation Y (Millennial generation): individuals born between 1982 – 2005.
Uncertainty: terrorism, globalization, economic recession, SARS outbreak
Values: online connectedness, teamwork, free expression, work-life flexibility, technology
Teaching: require clear instructions in everything, observable behaviors, explicit communication
No assumption of common knowledge

8. Fixed Traits?
Gladwell M. The tipping point: How little things can make a big difference. Little Brown publishing 2000.
Tipping point = the point where things change, ie., the threshold, the boiling point
Three rules of epidemics
The law of the few
The stickiness factor
The power of context

9. Fixed Traits?
Self DJ Baldwin DC, Jr. Does medical education inhibit the development of moral reasoning in medical students? A cross-sectional study. Academic Medicine 1998; 73: S91-3.
Patenaude J, Niyonsenga T, Fafard D. Changes in the components of moral reasoning during students’ medical education: A pilot study. Medical Education 2003; 37: 822 – 9.
The usual age-appropriate increase in medical students’ moral reasoning scores did not occur, suggesting that the experience of medical training inhibited moral development rather than facilitated it.

10. I’m not Good Enough!
Stern DT, Papadakis M. The developing physician – Becoming a professional. N Eng J Med 2006; 355:
A role model is “someone who, in the performance of a role, is taken as a model by others.” Role modeling is in the eye of the beholder — the student, not the teacher. “Individuals who are seen as mentors may not realize that they are teaching professional values, and those not seen as mentors may believe that they are.”

11. Teaching Medical Professionalism
Formal curriculum
Ethics courses
Ethics case discussion
Ethical conference
Ethical round
Hidden curriculum
Environment: moral culture of norms and values
Parables
Role models

12. Questions & Comments Cherdsak.ira@mahidol.ac.th
Instructional techniques