professionalism in healthcare education 12 issue 1... · shwetha km1*, sivaranjani gali 2...
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Journal of Dental & Oro-facial Research Vol 12 Issue 1 Jan 2016 JDOR
MSRUAS 14
REVIEW
PROFESSIONALISM IN HEALTHCARE
EDUCATION
Shwetha KM1*, Sivaranjani Gali 2 *Corresponding Author Email: [email protected]
Contributors:
1 Reader,
PSG-FRI fellow 2014,
Department of Public Health
Dentistry, FDS, MSRUAS,
Bangalore
2 Reader, Department of
Prosthodontics, FDS, MSRUAS,
Bangalore
ABSTRACT
As healthcare professionals, we occupy a respectable status in the society
due to the responsibility and accountability that our health profession demands.
Thus, there is a greater need to incorporate all the required competencies into our
educational curriculum for students to provide quality health care. One of the core
competencies that must be instilled in our students is Professionalism. Institutions
can adopt such core competencies subject to the mandatory rules of the regulatory
bodies and health professionals can teach only if included in our curriculum.
Therefore, this paper discusses about components of professionalism, teaching and
assessment methods for instilling professionalism among students.
INTRODUCTION:
Health care professionals are given certain privileges in the
society due to the nature of their contributions (1). Doctors
are characterised by their strong commitment towards
patient’s well-being, high standards of ethical conduct, their
mastery in learning knowledge and acquiring skills, and self-
regulation (2). Professionalism is one of the competencies a
healthcare professional should and must possess. In fact,
Accreditation Council for Graduate Medical Education
(ACGME) suggests teaching of professionalism to students
during their training period (3). The objective of this paper
is to emphasise on professionalism in health care, its
components, methods/ ways of teaching and assessment.
“Professionalism” is derived from the Latin professio or
public declaration. A definition of profession is “a calling
requiring specialized knowledge and often long and
intensive preparation including instruction in skills and
methods as well as in the scientific, historical, or scholarly
principles underlying such skills and methods, maintaining
by force of organization or concerted opinion high standards
of achievement and conduct, and committing its members to
continued study and a kind of work which has for its prime
purpose the rendering of a public service”. Professionalism
is constituted by the goals, attributes and behaviours of
profession (4). Its attributes are communication, empathy,
integrity, compassion, responsibility, respect, duty, altruism,
self-regulation, ability to understand limitations and eager to
improve the skills and knowledge (5–8) (Fig 1).
Professionalism is concerned about the moral aspects such
as norms, values and behaviour of a doctor during their
practice (9). Professionals must render quality care to
patients above their self-interest. Such attitudes and
behaviours are not taught in a regular medical or dental
curriculum, but were part of hidden curriculum which means
it’s not part of formal education (5,10–14).
Fig.1 Attributes of professionalism (Arnold and Stern 2006)
The emphasis is to include professionalism in routine
curriculum of undergraduate and postgraduates, as it is
considered as second order competence (9). As
professionalism is demonstrated while practicing our core
competency for patient care (15) which has to be taught
during their training, students learn to practice with
commitment and accountability. Students must also learn to
balance between financial aspects, the ethical and moral
values (16). As health care professional educators, we must
reflect upon the various competences we are equipping our
graduates to meet health care needs and expectation of
society (17). First and foremost, teachers of health
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profession education must be clear as teaching
professionalism is not as simple as teaching cognitive and
clinical skills.
Teaching professionalism
The classic triad of professionalism consists of a high level
of intellectual and technical expertise, autonomy in the
practice and regulation of the discipline, and a commitment
to public service (18). The core competency of intellectual
and technical expertise is taught through a well-structured
curriculum. But there is no formal and informal training
regarding discipline, the humanism attitudes and behaviours.
The Accreditation Council for Graduate Medical Education
(ACGME) accepts professionalism as one of the
competencies to be acquired by the medical students and
have to be taught during students training years, but it’s a
challenge to teach as regular subjects. It’s like teaching them
how to swim or ride the bicycle; it will be learnt by practice
(3,19). Nevertheless it should start as early as possible and
followed till they complete the graduation.
Professionalism includes non-cognitive skills(5) that can be
taught using Dreyfus adult skill acquisition model as
suggested by David Leach (19). This model explains the
stages a novice acquire skills to become an expert (fig.
2).The objectives, teaching learning methods and the
assessment can be suggested like a blueprint by the
governing bodies or university. Anne Stephenson et al
suggested three key aims to be achieved during the medical
school. One, is to understand the origins of professionalism
and the responsibilities, second to instil the professional
behaviours in medicine and third, to understand the concept
and demonstrate in their work and willingness to continue to
develop their skills (18).
Teaching begins in the institution by defining what is
expected from the student and the expected behaviours and
non-expectable behaviours as policy statements (5). Having
Fig. 2 Based on five-stage model of adult skill acquisition
Dreyfus (26)
the curriculum and policies helps teachers to focus on
teaching professionalism to students. The faculty
development programs for teachers should be conducted to
train them about the importance, teaching methods and
assessment of students for professionalism. The support
from other disciples such as sociology, philosophy, political
science and other humanities can also be planned (18).
Innovative methods in large or small group teaching,
reflective or experiential learning methods or role plays,
group discussions based on clinical scenario or case
vignettes, standardised patients, can be used (20).
Klemenc-Ketis et al used cinemeducation as method to teach
professionalism. The authors concluded that controlled
environment of movies enabled students to explore values
and attitudes without affecting their personal integrity
through a qualitative study. The other methods such as use
of drama/theatre, observing the doctors in the wards are also
suggested (11). These methods can be used during
classroom, clinics, wards, field programs and workshops.
Good role modeling is an important method that students
follow and remains a cornerstone in education. Therefore
educators should personify the values, attitude and other
professional behaviours in their daily routine as students will
be observing and imitating them (18).
Assessing students for professionalism
A great medical educationalist Miller said “assessment
drives learning” (21). Students read and learn merely for the
purpose of examination. Hence assessment is an important
aspect of educational spiral. As Cob’s once said "We get
what we assess, and if we don't assess it, we won't get it".
Assessing professionalism in students helps to ensure the
basic values, etiquette, attitudes and behaviours that are
expected from a health professional.
Formative assessment is one of the methods suggested to
assess professionalism. This should align with objects and
methods used for teaching and learning. The assessment and
feedback in the early stages helps to develop and instill the
expected behaviours and the opportunity to improve
Fig3. Miller’s pyramid for assessment
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Table 1 Examples linking professional values with the behaviour and teaching assesmnet
and internalise. The assessment can be based on the
conceptual model of clinical competence by Miller (9,22)
(Fig. 3).
Written tests, multiple choice questions, reflections on the
scenarios, role-play and feedback, portfolios, standardised
patients feedback, Mini-Clinical examination (CEX),
Professionalism Mini-Evaluation Exercise (P-MEX), patient
satisfaction reports and others workplace
assessment methods can be used. As there are multiple
aspects of the professionalism with respect to students
behaviour 360 degree assessment can be used or multiple
methods can be used for assessment (5,8,9,16,23–25).
Multiple assessment methods can be used to assess students
depending on the defined learning outcome. (Table 1).
Conclusion: Our students must be equipped with the
competencies that are expected from society.
Professionalism was part of hidden curriculum and the need
for its inclusion in values, morals, attitudes and behaviours
must be followed by a health professional.
Acknowledgements:
We would like to acknowledge Dr.K.Pushpanjali, Registrar
Academics, MSRUAS, FAIMER fellow 2013 for her
valuable inputs and all the faculty and PSG-FRI,
Coimbatore fellows for providing the resources.
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Values Behaviours Learning
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Teaching Assessment
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