Walther N. K. A. van Mook

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.

The concepts of professionalism and professional behaviour: Conflicts in both definition and learning outcomes

This article is the second in a series on professionalism in the European Journal of Internal Medicine. The current article will first focus on these different views and definitions that are currently adopted by the various researchers, and subsequently discuss the consequences for the training and assessment of professionalism and professional behaviour in medical education.

Using focus groups in medical education research: AMEE Guide No. 91

Abstract Qualitative research methodology has become an established part of the medical education research field. A very popular data-collection technique used in qualitative research is the “focus group”. Focus groups in this Guide are defined as “… group discussions organized to explore a specific set of issues … The group is focused in the sense that it involves some kind of collective activity … crucially, focus groups are distinguished from the broader category of group interview by the explicit use of the group interaction as research data” (Kitzinger 1994, p. 103). This Guide has been designed to provide people who are interested in using focus groups with the information and tools to organize, conduct, analyze and publish sound focus group research within a broader understanding of the background and theoretical grounding of the focus group method. The Guide is organized as follows: Firstly, to describe the evolution of the focus group in the social sciences research domain. Secondly, to describe the paradigmatic fit of focus groups within qualitative research approaches in the field of medical education. After defining, the nature of focus groups and when, and when not, to use them, the Guide takes on a more practical approach, taking the reader through the various steps that need to be taken in conducting effective focus group research. Finally, the Guide finishes with practical hints towards writing up a focus group study for publication.

Professionalism: evolution of the concept.

The concept of professionalism has undergone major changes over the millennia in general and the last century specifically. This article, the first in a series of articles in this Journal on professionalism, attempts to provide the reader with a historical overview of the evolution of the concept of professionalism over time. As a result of these changes, medical school curricula, and contemporary specialist training programs are increasingly becoming competence based, with professionalism becoming an integral part of a residents training and assessment program.

Integrating professionalism into the curriculum: AMEE Guide No. 61

Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a–g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.

Gas within the wall of the stomach due to emphysematous gastritis: case report and review.

Emphysematous gastritis is a rare variant of phlegmonous gastritis due to invasion of the stomach wall by gas-forming bacteria. We present a case of emphysematous gastritis in a 66-year-old woman admitted with Staphylococcus aureus septicaemia, and a review of gas in the wall of the stomach is given with focus on emphysematous gastritis.

Integrating professionalism into the curriculum

Professional values and behaviours are intrinsic to all medical practice yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism in the twenty-first century raises challenges not only for the adaptation of the medical training programme to changing societal values but also for ensuring that trainees gain the skills for self-directed continuous development and future revalidation. This article is an introduction to the AMEE Guide in Medical Education No 61: Integrating Professionalism into the Curriculum (www.amee.org), which is based on the extensive contemporary available literature. An evidence-based approach has been taken throughout the Guide as it focuses on instilling professionalism positively into both undergraduate and postgraduate training. It takes a structured, stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning of the trainee. A few well-evaluated case studies for both teaching and assessment have been selected to illustrate the recommendations.

Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death*

Objective:Organ donation after cardiac death increases the number of donor organs. In controlled donation after cardiac death donors, the period between withdrawal of life-sustaining treatment and cardiac arrest is one of the parameters used to assess whether organs are suitable for transplantation. The objective of this study was to identify donation after cardiac death donor characteristics that affect the interval between withdrawal of life-sustaining treatment and cardiac death. Design:Prospective multicenter study of observational data. Patients:All potential donation after cardiac death donors in The Netherlands between May 2007 and June 2009 were identified. Interventions:None. Measurements and Main Results:Of the 242 potential donation after cardiac death donors, 211 entered analysis, 76% of them died within 60 mins, and 83% died within 120 mins after withdrawal of life-sustaining treatment. The median time to death was 20 mins (range 1 min to 3.8 days). Controlled mechanical ventilation, use of norepinephrine, absence of reflexes, neurologic deficit as cause of death, and absence of cardiovascular comorbidity were associated with death within 60 and 120 mins. The use of analgesics, sedatives, or extubation did not significantly influence the moment of death. In the multivariable logistic regression analysis, controlled mechanical ventilation remained a risk factor for death within 60 mins, and norepinephrine administration and absence of cardiovascular comorbidity remained risk factors for death within 120 mins. The clinical judgment of the intensivist predicted death within 60 and 120 mins with a sensitivity of 73% and 89%, respectively, and a specificity of 56% and 25%, respectively. Conclusion:Despite the identification of risk factors for early death and the additional value of the clinical judgment by the intensivist, it is not possible to reliably identify potential donation after cardiac death donors who will die within 1 or 2 hrs after life-sustaining treatment has been withdrawn. Consequently, a donation procedure should be initiated in every potential donor.

Approaches to professional behaviour assessment: tools in the professionalism toolbox.

There is general agreement that professionalism and professional behaviour should be (formatively and summatively) assessed, but consensus on how this should be done is still lacking. After discussing some of the remaining issues and questions regarding professionalism assessment, this article discusses the importance of qualitative comments to the assessment of professional behaviour, focuses on the currently most frequently used tools, as well as stresses the need for triangulation (combining) of these tools.

Peripartum cardiomyopathy: a condition intensivists should be aware of

We use an illustrative case of severe peripartum cardiomyopathy with congestive heart failure to introduce this topic and proceed to cover its pathophysiology, incidence, management and outcome.