Defining the Path of Professionalism in the Curriculum

Objectives:

1. Explore the relation between professionalism in medicine and good communication skills.
2. Identify a set of communication skills requisite for developing exemplary professional behavior.
3. Identify practical strategies for developing this crucial skill set.

It is increasingly apparent that conduct of research, and academic life in general, presents challenges to character that too often lead to unfortunate ethical failures:  exciting findings that prove to be overstated or falsified, pharmaceutical companies that neglect to acknowledge a product's deleterious effects, abuses of the peer-review system that governs publication and grant funding.  Furthermore, advances in technology continue to bring additional new challenges to standards of research practice.  The NIH and NSF are responding with enhanced effort to monitor research and researchers, that includes support of certifiable training and education of students.  For many years Wake Forest has used a case-centered, problem-based method for preclinical basic science instruction, and it was decided to adapt this method for small-group tutorials of graduate students that focus on bioethics, professionalism and responsible conduct of research.   The session will describe the method, case design, overt and hidden learning goals, and some preliminary results on the curriculum's effectiveness in shaping comprehension and attitudes of future professionals.

The objectives of this session are to discuss various approaches to the assessment of professional behaviors, to describe the elements of the National Board of Medical Examiners' Assessment of Professional Behaviors program, and to identify the strengths and challenges of using a multisource feedback process in assessing performance. We will describe methods that use a structured stimulus, ranging from paper-based ethics examinations to objective structured clinical encounters (OSCEs) with simulated patients. We will also describe a variety of "embedded" observational methods - those using data derived from day-to-day work activities - and their potential advantages in providing credible information on how trainees actually behave in a naturalistic setting. An ideal assessment optimizes the balance between reliability, validity, feasibility, acceptability to users, and educational impact. Multisource feedback holds particular promise for balancing these often conflicting priorities in assessing professionalism and related "difficult" competencies. The NBME's Assessment of Professional Behaviors is a developmental multisource feedback program initially intended to provide resident physicians with formative, actionable feedback on their professional behaviors as observed by peers, supervisors, and health professionals in the training environment. Initial pilot work has demonstrated this program's feasibility and utility, and we hope to make it a national standard in the coming years.

Presenter:  Dr. Peter Katsufrakis and Dr. Matt Holtman

Dr. Plaut will outline characteristics of the teacher-student relationship and will briefly review legal, policy and ethical standards that govern such relationships.  Aspects of such relationships that are sometimes problematic include student abuse or mistreatment, excessive intimacy, and perceptions of either abuse or intimacy that may compromise the social setting in which students live and learn.  Both faculty and student responsibilities for appropriate teacher-student boundaries will be discussed.  Factors that put both faculty and students at risk for relationship problems will be addressed, as will attitudes and behaviors likely to foster appropriate teacher-student boundaries. Short vignettes describing faculty-student boundary issues will be presented for discussion.

Session Objectives:

1.      Describe the basis for appropriate boundaries in teacher student relationships in the medical education setting,

2.      Become familiar with professional standards that govern appropriate faculty-student relationships,

3.      Describe the individual and collective harm that can result from either mistreatment of or excessive intimacy with students,

4.      List factors that can put both faculty and students at risk for crossing inappropriate boundaries in the faculty-student relationship, and

5.      State guidelines designed to foster wholesome faculty- student relationships.

Presenter: Dr. S. Michael Plaut, Ph.D.

In this session we will review issues of medical professionalism using the hidden curriculum as a conceptual and methodological lens into issues of professional preparation with an emphasis on medical education. We will provide definitions, but focus more on how to utilize the general concept as an investigatory and problem solving tool. We then will move into a review of modern day medicine's professionalism movement dating to the mid 1980s. Within this review, we will trace the evolution of this movement through successive waves of medicine's identification of a crisis, followed by efforts to create definitions and measurement tools, the institutionalization of these efforts, followed by a newly emerging shift from a professionalism of motives to a professionalism of structure. We will also review one of the unintended consequences of efforts to move professionalism from the hidden to the formal curriculum. Centering on the LCME's newest accreditation standard, MS-31-A, we will explore the role of the HC in creating this standard and how the concept of "learning environments" has become a proxy for the HC. We will close with a brief overview of how we might use social network analysis as one tool for examining both the HC and learning environments.

Session Objectives include understanding the hidden curriculum as a dynamic and usually invisible partner to the formal curriculum and how we might use the tools of network analysis for exploring these interactions.

Presenter: Fred Hafferty, Ph.D.

In this session, I will discuss the role of peers in evaluating professional behavior. Peers may know the most about each other's professional behaviors, but are also the most unlikely to provide candid feedback on those behaviors. Peer pressure, the close working relationships of peers, and the desire for confidentiality all make these assessments complex. I will discuss some of the research on using peers for the assessment of professionalism, and how we can create a safe and effective context in which their comments and critiques can be used.

David Stern, M.D., Ph.D.