Richard L. Cruess

Role modelling--making the most of a powerful teaching strategy.

Teachers need to be aware of the conscious and unconscious components of learning from role modelling, so that the net effect of the process is positive

Teaching professionalism: general principles.

There are educational principles that apply to the teaching of professionalism during undergraduate education and postgraduate training. It is axiomatic that there is a single cognitive base that applies with increasing moral force as students enter medical school, progress to residency or registrar training, and enter practice. While parts of this body of knowledge are easier to teach and learn at different stages of an individuals career, it remains a definable whole at all times and should be taught as such. While the principle that self-reflection on theoretical and real issues encountered in the life of a student, resident or practitioner is essential to the acquisition of experiential learning and the incorporation of the values and behaviors of the professional, the opportunities to provide situations where this can take place will change as an individual progresses through the system, as will the sophistication of the level of learning. Teaching the cognitive base of professionalism and providing opportunities for the internalization of its values and behaviors are the cornerstones of the organization of the teaching of professionalism at all levels. Situated learning theory appears to provide practical guidance as to how this may be implemented. While the application of this theory will vary with the type of curriculum, the institutional culture and the resources available, the principles outlined should remain constant.

Teaching medicine as a profession in the service of healing

As society, including the medical profession, moves into a new century, the rate of change in the relationship between professions and society is unprecedented. All societies need healers, and in the English-speaking world the services of the physician-healer have been organized around the concept of the professional. The great increase in both state control and corporate involvement has seriously intruded into the traditional autonomy enjoyed by both the medical profession and individual physicians, and further changes can be expected. More physicians are becoming either employees or managers in the state or corporate sector, while others are being forced to compete in a marketplace that rewards entrepreneurial behavior. It is the responsible behavior of the professional that will protect the role of the healer. Medicine has been rightly criticized for placing undue emphasis on both income and power and for protecting incompetent or unethical colleagues; and it has failed to accept responsibility for injustices or inequities in health care systems and has moved slowly to address new diseases or issues. Nonetheless, all evidence indicates that society still values the healer-professional and does not wish to abandon professionalism as a concept--it appears to prefer an independent and knowledgeable professional to deal with its problem rather than the state or a corporation. For this reason, medicines professional associations and academic institutions must ensure that all physicians understand professionalism and accept its obligations. In doing so, the objective should be to encourage the moral and intellectual growth of physicians by setting standards based on higher aspirations than can or should be enforced. In facing the complex world of our future, such action will both serve society and maintain the integrity of the profession.

Faculty development for teaching and evaluating professionalism: from programme design to curriculum change.

Introduction  The recent emphasis on the teaching and evaluation of professionalism for medical students and residents has placed significant demands on medicines educational institutions. The traditional method of transmitting professional values by role modelling is no longer adequate, and professionalism must be taught explicitly and evaluated effectively. However, many faculty members do not possess the requisite knowledge and skills to teach this content area and faculty development is therefore required.

Profession: A Working Definition for Medical Educators

Purpose: To provide a working definition of professionalism for medical educators. Summary: Thus far, the literature has not provided a concise and inclusive definition of the word profession. There appears to be a need for one as a basis for teaching the cognitive aspects of the subject and for evaluating behaviors characteristic of professionals. Furthermore, a knowledge of the meaning of the word is important as it serves as the basis of the contract between medicine and society, and hence, of the obligations required of medicine to sustain the contract. A definition is proposed based on the Oxford English Dictionary and the literature on the subject. It is suggested that this can be useful to medical educators with responsibilities for teaching about the professions, professional responsibilities, and professional behavior. Conclusions: The proposed definition is as follows: Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.

Assessment of professionalism: Recommendations from the Ottawa 2010 Conference

Over the past 25 years, professionalism has emerged as a substantive and sustained theme, the operationalization and measurement of which has become a major concern for those involved in medical education. However, how to go about establishing the elements that constitute appropriate professionalism in order to assess them is difficult. Using a discourse analysis approach, the International Ottawa Conference Working Group on Professionalism studied some of the dominant notions of professionalism, and in particular the implications for its assessment. The results presented here reveal different ways of thinking about professionalism that can lead towards a multi-dimensional, multi-paradigmatic approach to assessing professionalism at different levels: individual, inter-personal, societal–institutional. Recommendations for research about professionalism assessment are also presented.

Expectations and Obligations: Professionalism and Medicine's Social Contract with Society

As health care has become of great importance to both individual citizens and to society, it has become more important to understand medicine’s relationship to the society it serves in order to have a basis for meaningful dialogue. During the past decade, individuals in the medical, legal, social sciences, and health policy fields have suggested that professionalism serves as the basis of medicine’s relationship with society, and many have termed this relationship a social contract. However, the concept of medicine’s social contract remains vague, and the implications of its existence have not been fully explored. This paper endorses the use of the term social contract, examines the origin of the concept and its relationship to professionalism, traces its evolution and application to medicine, describes the expectations of the various parties to the contract, and explores some of the implications of its use.

Osteonecrosis of bone. Current concepts as to etiology and pathogenesis.

Experimental and some clinical evidence suggest that one or more mechanisms, alone or in combination, induce bone necrosis. These include marrow cell hypertrophy, microembolic phenomena, and lipid-induced osteocyte necrosis. Such events may result in local inflammatory exudates and/or vascular impedence. Either may effect an increase in the hydrostatic pressures in bone with the potential to limit blood flow and magnify the initial insult. Further experimental investigations are necessary to gain knowledge of etiologic mechanisms and a rational means of prophylaxis or treatment.

Professionalism: an ideal to be sustained.

2–4 as society’s need for the healer and its belief in the inherent virtue and morality of professionalism have served as the basis of modern medicine. 5,6 They are the source of the rights and privileges granted to the medical profession and of the values that physicians feel contribute to what is noble and good in their calling. Recently, a series of highly publicised events has encouraged the view that the medical profession fails to meet many of the obligations required to sustain its professionalism. In all countries, irrespective of the structure of the health-care system, threats to the values of professionalism are seen. 1 As physicians and society try to bridge the gap widened by the perceived lapses in professional standards, a redefinition of expectations and roles is taking place. To prevent medicine from becoming a commodity in a market-oriented world, physicians must participate in shaping the profession’s future and understand the principles and obligations associated with being a member of a profession. Role of professionalism Society has used the concept of the profession to organise and deliver many of the complex services it requires, with the rationale that the expertise necessary to the practice of certain vocations is not easily comprehensible to the average citizen. 2,3,5,6

The Professionalism Mini-evaluation Exercise: a preliminary investigation.

Background As the evaluation of professional behaviors has been identified as an area for development, the Professionalism Mini-Evaluation Exercise (P-MEX) was developed using the mini-Clinical Examination Exercise (mini-CEX) format. Method From a set of 142 observable behaviors reflective of professionalism identified at a McGill workshop, 24 were converted into an evaluation instrument modeled on the mini-CEX. This instrument, designed for use in multiple settings, was tested on clinical clerks in medicine, surgery, obstetrics and gynecology, psychiatry, and pediatrics. In all, 211 forms were completed on 74 students by 47 evaluators. Results Results indicate content and construct validity. Exploratory factor analysis yielded 4 factors: doctor–patient relationship skills, reflective skills, time management, and interprofessional relationship skills. A decision study showed confidence intervals sufficiently narrow for many measurement purposes with as few as 8 observations. Four items frequently marked below expectations may be identifiers for “problem” students. Conclusion This preliminary study suggests that the P-MEX is a feasible format for evaluating professionalism in clinical training.