PROFESSIONALISM CURRICULUM

Overall Goal

To enhance the resident’s appreciation of and commitment to a core set of values, attitudes and behaviors that motivate physicians to make the interests of patients and society their first priority. This includes a commitment to the highest standards of excellence in practice, a commitment to know and protect the interests of individual patients, and a commitment to be responsive to the health care needs of society. *

*elements of professionalism identified by the American Board of Internal Medicine

Specific Learning Objectives
  1. Knowledge

    1. Be able to list and define the core elements of professionalism
    2. Understand professional attributes such as altruism, accountability, excellence, duty, service, honor, integrity, and respect for others
    3. Appreciate the forces challenging professionalism

  2. Practice Skills and Attitudes

    1. Demonstrate a personal sense of altruism by consistently acting in the best interests of patients
    2. Maintain accountability by fulfilling all agreements
    3. Demonstrate a commitment to standards for life-long excellence
    4. Demonstrate a sustained commitment to service
    5. Demonstrate honesty and integrity
    6. Avoid conflicts of interest and relationships that may supersede the best interests of patients
    7. Behave in a respectful manner to colleagues and other members of the health care team
    8. Behave in a respectful fashion to patients and families
    9. Demonstrate the ability and willingness to admit error
    10. Demonstrate an awareness of ongoing stresses of patient care and medical training and the capacity to recognize and address dysfunctional coping patterns in self and others

  3. Learning Methodology

    1. Support groups for interns and upper level residents: Time-Out luncheons
    2. Leadership and team-building skills: Ropes Course for primary care interns
    3. Conferences, morning report, noon conference, and grand rounds
    4. Role-modeling by faculty
    5. Selected readings:

 

We believe that the most important and effective means of teaching professionalism in medicine is the role-modeling that takes place among faculty, residents, and students in every clinical, educational, and research venue.  Likewise, observation of resident behavior in each of these venues provides the most meaningful assessment tool.  Beyond this cornerstone method of teaching and assessing professionalism which occurs on every rotation, the activities listed below emphasize specific aspects of professionalism.

Experience/Activity

When

Where

Who

Methods/Goals

Tools of Assessment

Assessors

Principles of Professionalism Conference

8 small-group sessions during the intern year, during the two one-month ambulatory blocks

IMRP conference room

HOI

Interactive sessions in which the fundamental principles of professionalism and ethics are introduced and discussed.  Case vignettes, brought by both the interns and the facilitator, serve as a major educational tool for group discussion

Observation of each intern’s contributions to group discussions.

Self-assessment exercise.

Final essay exam in which the interns are asked to discuss the ethical aspects of several case studies.

Group facilitators

 

Interns

 

Course director

Communications Conference

8 small-group sessions during the intern year, during the two one-month ambulatory blocks

IMRP conference room

HOI

Many professional and ethical issues are discussed in this format, including honesty, cultural sensitivity, and bearing bad news

Observation of each intern’s contributions to group discussions.

 

Group facilitators

 

NCBH Housestaff Common Curriculum

Self-study modules to be completed during each year of residency

NCBH Intranet

HOI,

HOII, HOIII

Tutorials regarding specific professional and ethical challenges in medicine

On-line examination taken after each module

NCBH Housestaff

Coordinator

Community Plunge

Ambulatory block

Community

HOI

Tour of Winston-Salem by automobile, including neighborhoods of our patients.  The tour ends with a visit to a community center where interns meet with local residents to discuss their challenges in receiving health care and services

No formal assesment

 

Ward rotations

Monthly rotations throughout the residency

Hospital-based

(NCBH)

HOI,

HOII, HOIII

Role-modeling patient advocacy, interactions with patients and their families, and relations with peers and other health professionals in the inpatient setting

Observation, recorded as part of the rotation evaluation

360 degree evaluation

Ward Attending

Peer evaluation

 

NCBH Nursing

Subspecialty Consult rotations

Monthly rotations

Hospital-based and outpatient clinics

HOII,

HOIII

Role-modeling effective consultation in which both clinical and educational service is provided to physicians and their patients in a kind and respectful manner

Observation, recorded as part of the rotation evaluation

 

Consult Attending

Subspecialty Fellows

Continuity Clinic

Weekly, throughout the residency

OPD and DHP clinics

HOI, HOII,

HOIII

Role-modeling patient advocacy, interactions with patients and their families, and relations with other health professionals in the outpatient setting

Observation, recorded as part of the rotation evaluation

360 degree evaluation

Clinic Preceptors

 

Clinic staff

 

Resources for Principles of Professionalism Conference

  1. Brennan TA, Blank L, Cohen J, et al.  Medical Professionalism in the New Millennium: A Physician Charter.  Ann Intern Med. 2002;136:243-246.

  2. Barry D, Cyran E, Anderson, RJ. Common issues in medical professionalism: Room to grow. Am J Med. 2000;108:136-42.

  3. Rosenbaum JR, Bradley EH, Holmboe ES, et al.  Sources of ethical conflict in medical housestaff training: A qualitative study.  Am J Med. 2004;116:402-407.

  4. Green MJ, Farber NJ, Ubel PA, et al. Lying to each other: When internal medicine residents use deception with their colleagues.  Arch Intern Med. 2000;160:2317-2323.

  5. Hebert PC, Meslin EM, Dunn EV.  Measuring the ethical sensitivity of medical students: A study at the University of Toronto.  J Med Ethics. 1992;142-147.

  6. Iniu TS.  A Flag in the Wind: Educating for Professionalism in Medicine.  Washington, DC: Association of American Medical Colleges., 2003.

  7. Feldman MD, Zhang J, Cummings SR.  Chinese and U.S. Internists adhere to different ethical standards.  J Gen Intern Med. 1999;14:469-73.

  8. Gruen RL, Pearsons SD, Brennan TA. Physician-Citizens: Public roles and professional obligations.  JAMA. 2004;291:94-98.

  9. Snyder L, Leffler C. Ethics manual. Ann Intern Med. 2005;142:560-582.

 

January 2006