FREDERIC W. HAFFERTY PH.D.PROFESSOR

UNIVERSITY OF MINNESOTA

SCHOOL OF MEDICINE–DULUTH

Professionalism, Best Evidence & Medical Education:  

A Cautionary Tale

December 11, 2009Warwick Medical School

The University of Warwickfhaffert@d.umn.edu

Caring versus credentials

Caring versus credentials

A TIMELINE

BACKGROUND & CONTEXT

U.S. Medicine’s Modern-Day Professionalism Movement

Key Sub-Movements[WAVES]

The call for better definitions

The call for better measurement tools

The institutionalization of definitions and tools

The [possible] shift from an individual motives-based conception of professionalism to a structural view of professionalism

U.S. Medicine’s Modern-Day Professionalism Movement

Professionalism & The Hidden Curriculum

“…the chief barr ier to medical professional ism education is unprofessional conduct by medical educators , which is protected by an establ ished hierarchy of academic authority. Students feel no such protect ion, and the current structure of professional ism education and evaluation does more to harm students ' v irtue, confidence, and ethics than is general ly acknowledged.”

Professionalism and the Hidden Curriculum: A Critique

Brainard and Brislen: “Learning professionalism: A view from the trenches."

Academic Medicine, 82:1010-1014; 2007.

U.S. Medicine’s Modern-Day Professionalism Movement

The Conflicted Nature of COI

“Unprofessional commercialism”

versus

‘appropriate’ commercial activity

Media Coverage: ABC News

Wall Street Journal

An Editorial from the Boston Globe

A Series of Articles from the Milwaukee Sentinel

Milwaukee Sentinel

A Graphic From The Same News Story

Milwaukee Sentinel

AMSA’s PharmFree Scorecard

AMSA’s Scorecard

Original Study

Original Study

TENSIONS

COI as a personal insult [people get insulted when you even raise the issue]

COI as evidence-based [we do have research]

The dependence on outside funding to run the educational enterprise

AAMC Report

MANAGE

An Opening Salvo

The Myths

Small Gifts

Full Disclosures

Chimonas, S., Brennan, T. A. & Rothman, D. J. Physicians and drug representatives: Exploring the dynamics of the relationship. Journal of General Internal Medicine 22, 184-

190 (2007)

Chimonas, S., Brennan, T. A. & Rothman, D. J. Physicians and drug representatives: Exploring the dynamics of the relationship. Journal of General Internal Medicine 22, 184-

190 (2007)

The Rub

The Nub

Minneapolis Star Tribune

THE CLASH

EliminationVersus

Management

Traditional Organizational Map

Krebs, Valdis. “Managing the 21st Century Organization.” IHRIM Journal 11, no. 4 (2007): 2-8.

How Work Actually Gets Done

Krebs, Valdis. “Managing the 21st Century Organization.” IHRIM Journal 11, no. 4 (2007): 2-8.

Map One

Map Two

Map 3

Map Four

A First Year Student Network

MAPPING CONCEPTS

Another Reference: Longitudinal and Integrated Medical Training

Hirsh, David A., Barbara Ogur, George Thibault, E., and Malcolm Cox. 2007. “'Continuity' as an organizing principle for clinical education reform." NEJM 356:858-866.

Recent JAMA COI Article

ACGME Competencies

Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals

Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

MEDICAL SCHOOLS MUST ENSURE THAT THE LEARNING ENVIRONMENT FOR

MEDICAL STUDENTS PROMOTES THE DEVELOPMENT OF EXPLICIT AND

APPROPRIATE PROFESSIONAL ATTRIBUTES (ATTITUDES, BEHAVIORS, AND IDENTITY)

IN THEIR MEDICAL STUDENTS.

T H E L E A R N I N G E N V I R O N M E N T I N C LU D E S F O R M A L L E A R N I N G A C T I V I T I E S A S W E L L A S ATT I T U D E S,

VA LU E S, A N D I N F O R M A L " L E S S O N S " C O N V E Y E D B Y I N D I V I D UA L S W I T H W H O M T H E S T U D E N T C O M E S

I N T O C O N TA C T.

MS-31-AThe Learning Environment

U.S. Medicine’s Modern-Day Professionalism Movement