MedicalProfessionalism

Srivieng Pairojkul, M.D.Department of Pediatrics

Faculty of MedicineKhon Kaen University

What is professionalism?

Behaviors reflecting professionalism

• Altruism - essence of professionalism.The best interest of the patients, not self-interest

• Accountability to individual patients,society and the profession

• Excellence - conscientious effort to exceed normal expectations and make a commitment to life-long learning

ABIM Project Professionalism 1999 www.abim.org/pubs/p2/index.htm

• Duty - commitment to service

• Honour and integrity - consistent regard for the highest standards of behaviour and refusal to violate ones personal and professional codes.

• Respect for others (patients and their families, other physicians and professional colleagues such as nurses, medical students, residents, subspecialty fellows,and self) is the essence of humanism…"

ABIM Foundation, ACP-ASIM Foundation and European Federation of Internal

Medicine (2002) created :

“A Physician Charter: Medical Professionalism in the New Millennium”

Sox H. Medical Professionalism in the New Millennium: A Physician Charter. Annals of Internal Medicine 2002 136: 243-246.

A PHYSICIAN CHARTER

• Fundamental Principles– Primacy of patient

welfare– Patient autonomy– Social justice

A PHYSICIAN CHARTERSet of professional commitment to:

– Professional competence– Honesty with patients– Patient confidentiality– Maintaining appropriate relations

with patients– Improving quality of care– Improving access to care– Just distribution of finite resources– Scientific knowledge– Maintaining trust by managing conflicts of interest– Professional responsibilities

19991999-- David Leach inspired effortDavid Leach inspired effort--define define residents by new residents by new ““Outcome measurementsOutcome measurements””

Creation of six new general competenciesCreation of six new general competenciesGoals of theGoals of the-- ACGME/RRC: alter some ACGME/RRC: alter some

of the focus of residency education by of the focus of residency education by measuring new outcomesmeasuring new outcomes

Patient CarePatient CareMedical KnowledgeMedical KnowledgeProfessionalismProfessionalismSystemsSystems--based Practicebased PracticePracticePractice--based Learning and based Learning and ImprovementImprovementInterpersonal and communication Skills Interpersonal and communication Skills

ความสามารถในการศึกษาตอเนื่องตลอดชีวิต มีทักษะการจัดการความรู ความสามารถในการทํางานเปนทีมทั้งกับแพทยและบุคลากรทางการแพทยสาขาอื่นๆ รวมทั้งกับประชาชน

ความสามารถในการคิดเชิงระบบ การคิดอยางมีวิจารญาณ และคิดเชิงจริยธรรม เพื่อใหสามารถตรวจสอบ และปรับปรุงคุณภาพ

ของระบบบริการไดอยางตอเนื่อง

ความสามารถในการสื่อสารและเขาใจในมนุษย เพื่อใหคําปรึกษา ใหความรูแกประชาชนไดอยางเปนองครวม

ความสามารถในการวิเคราะหปญหาสุขภาพ โดยเขาใจความเชื่อมโยงกับปจจัยตางๆ ภายนอกระบบบริการสุขภาพ เพื่อใหสามารถทํากิจกรรมสงเสริมสุขภาพและปองกันโรคอยางไดผล

Learning about professionalism

By instruction

From peers

From patients

From other colleagues

From experience

From feedback

By reflection

From medical staff

Bring some to medical school with Bring some to medical school with themthem

Learn some through the formal Learn some through the formal curriculumcurriculum

Learn some from role modelsLearn some from role models

Unprofessional behavior in Med School predicts unprofessional behavior

in practiceProblem behaviors in Med school described in course evaluations or

administrative correspondence predicted future discipline problems

Case-control study of all UCSF graduates disciplines by California Medical Board 1990-2000.

Papadakis M et al. Unprofessional behavior in Medical school is associated with subsequent disciplinary action by a state medical board.

Acad Med 2004; 79: 244-249.

Predictive Traits:unprofessional behavior in practice

• Low academic achievement• Severe irresponsibility• Diminished capacity for self-improvement

Case-control study of 235 graduates of UCSF, Jefferson, U of Michigandisciplined by 40 state medical boards 1990-2003.

Papadakis, M et al. Disciplinary Action by Medical Boards & Prior Behavior in Medical School. N Engl J Med 2005; 353: 2673-2682.