Annual Feature: in Progress: Reports of New Approaches in Medical Education: Professionalism
Association of American Medical Colleges
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE, LEXINGTON, KY
Inquiries: David W. Rudy, MD, Department of Medicine, Kentucky Clinic, Room K-512, Lexington, KY 40536-0284.
Objective: Throughout the medical curriculum are opportunities to introduce professionalism topics relevant to the students' current levels of experience. Although much of the focus on teaching medical professionalism is in the patient care environment, we contend that the development of professionalism skills begins earlier in medical training, during the preclinical years. Issues related to patient care might not be relevant to preclinical students. To that end, we are asking our students to help us define stage-appropriate professional skills and attitudes. The purpose of our investigation is to determine what professionalism issues first-year students believe are pertinent to their level of training. This information will be used to begin to develop a stage-appropriate professionalism curriculum.
Description: To introduce the American Board of Internal Medicine's professionalism framework (altruism, accountability, excellence, duty, honor and integrity, and respect for others) in an Introduction to the Medical Profession course, a video of faculty, residents, and students discussing professionalism in medicine was shown to first-year medical students of the entering class of 1999. Following review of the video, the students were asked to list how a first-year student might exhibit professionalism. Responses were received from 86 of the 95 students (91%). They listed 376 responses, an average of 4.4 per student. The responses were analyzed by themes by two raters, and any differences were resolved via consensus. The top categories of responses were: dedication to learning, listed by 60% of the students (diligence, lifelong learning, preparation for class); respect, 58% (for classmates, faculty, patients, other health care professionals); patient confidentiality, 43%; listening, 31% (in class, to patients); honesty, 35% (integrity, morality); dress and appearance, 29%; courtesy, 26%; teamwork, 26% (helping other students learn); empathy, 24%; favorable temperament, 20% (maturity, positive attitude, patience); knowledge of limitations, 20%; and punctuality, 19%.
Discussion: These first-year students' perceptions of necessary professional skills focused on behaviors relative to their current roles in their educational experience. The issues related to patient care, such as patient confidentiality and knowledge of limitations, appeared to be appropriate for their level of training. Applying the ABIM format to the survey results shows that the majority of responses fall into the categories of excellence (dedication to learning), honor and integrity (honesty), and respect for others (respect). Presenting first-year students with a professionalism curriculum primarily focused on patient-care issues may not be as relevant as focusing on issues more closely related to their level of training. Addressing issues such as dedication to learning, honesty, and respect may increase the relevance of professionalism to them. We are identifying students' perceptions of stage-appropriate professional skills and behaviors to devise stage-appropriate educational interventions to teach professionalism. Further questions include: Are there developmental stages in assimilating professional behaviors? Is honesty in the classroom a precursor to honesty in the clinical setting? Does courtesy to faculty and peers predict courtesy to patients, their families, and ancillary staff? How should a professionalism curriculum be designed?
Annual, Peer-reviewed Collection of Reports of Innovative Approaches to Medical Education