Enhancing Professionalism in Osteopathic Medical Education

AACOM

2007

Richard LaBaere, II, D.O., M.PH.

Genesys Regional Medical Center DME

Assistant Dean – Michigan Region ATSU - KCOM

John R. Gimpel, D.O., M.Ed.Vice President for Clinical Skills Testing NBOME Associate Professor of Family MedicineGeorgetown University School of Medicine

Patricia Sexton, M.S.

Assistant Professor, Biochemistry

ATSU-KCOM

Nehad El-Sawi, Ph.D.Associate Dean for Curriculum & Faculty EnrichmentATSU-SOMA

Medical Professionalism • What?

• What is it?• Why?

• Why is it important?• When?

• When does it develop?• Who?

• Who is responsible?• How?

• How do we teach and assess it?

Our work today…

• Introduction• Attributes of professionalism • Assessment of professionalism • Application and evaluation of real-life

scenarios • Next steps

Introduction

While the knowledge of medicine and While the knowledge of medicine and the skills required to practice the skills required to practice medicine are vital, medicine are vital, howhow knowledge knowledge and skills are applied is perhaps and skills are applied is perhaps more important …more important …

Students are learning from us Students are learning from us

when we least expect it…when we least expect it…

Driving Forces:

• The public• The Core Competencies• Institutional values

Trends Show Impact to State Boards• Increasing evidence of correlation between

problematic behavior in medical school and subsequent deficiencies in professionalism

• Papadakis, Terhani, et.al., NEJM, 2005• Papadakis, Hodgson, et.al., Academic Medicine

2004• Murden, Way, et.al., Academic Medicine 2004• Gimpel, Schwartz, et al, GUSOM 2003

Attributes of Professionalism

A definition:

• Professionalism is demonstrated Professionalism is demonstrated through a foundation of …competence, through a foundation of …competence, communication skills, and ethical and communication skills, and ethical and legal understanding…legal understanding…

……upon which is built the aspiration to upon which is built the aspiration to wise application of the principles of wise application of the principles of professionalismprofessionalism-- -- David Stern and Louise Arnold: Measuring Medical David Stern and Louise Arnold: Measuring Medical

professionalismprofessionalism

Mother Teresa on Professionalism• “When they come back from their

education, they are concerned about titles and offices and parking privileges. So take all of that away from them and send them to the hospice of the dying. There they hold people’s hands, and pray with them and feed them. After six months of that, they typically get things straight again…”

Being “Professional”

• Professionals honor the idea that the rewards of the profession emanate from service, not entitlement

• The litmus test for professionalism lies in the root of the behavior

Assessment of Professionalism

Sign Hanging In Einstein’s Office at Princeton

• “Not everything that counts can be counted, and not everything that can be counted counts.”

Competency Assessment

DoesDoes

Shows howShows how

Knows howKnows how

KnowsKnows

Performance assessment in Performance assessment in vivo:vivo: SPs, Video, Sim, Portfolios, SPs, Video, Sim, Portfolios, LogsLogsPerformance assessment Performance assessment

in vitro:in vitro:OSCE, SP-based test, OSCE, SP-based test, MJTsMJTs(Clinical) Context (Clinical) Context

based tests:based tests:MCQ, essay type, MCQ, essay type, oral…oral…Factual tests:Factual tests:MCQ, essay type, MCQ, essay type, oral…oral…

Learners Value What You Test…

• Authentic assessment- realistic• Admission Practices• Institutional plan and symmetry• Formative or Summative?• Use multiple raters and multiple types of

measurement to enhance validity• CQI

Case Scenarios• Report back with the answers to these 3

questions:• What is the professionalism issue?

• What tools would you use to assess professionalism in this instance?

• What could be done on an individual or institutional level to prevent this behavior from occurring or, to reinforce the behavior?

Summary• A common definition is important

• Behaviors and attitudes are learned implicitly and explicitly – we must reward what we value and give effective feedback about inappropriate behavior.

• Think about the institutional culture you wish to create

Continue the Dialogue…