A professionalism program in medical education and training – From broad values to specific applications: YLL School of Medicine, Singapore

Abstract

The process for introducing and developing a program for teaching medical professionalism at the National University of Singapore, School of Medicine is outlined. Professionalism was recognised as embracing ‘honesty and integrity,’ ‘responsibility and participation,’ ‘respect and sensitivity,’ and ‘compassion and empathy.’ Those broad values are expressed as specific attitudes and behaviours that are taught and assessed throughout the course. Honesty and integrity, for example, are demonstrated by ‘presenting original, authentic assignments’ (in medical education); and ‘accepting personal mistakes and honestly acknowledging them’ (in clinical training and practice). Values and items of behaviour were drawn from the literature, and reviewed and refined to address needs identified within the Medical School. A broad spectrum of pre-clinical and clinical teachers contributed to this development. The program was reassessed to determine the extent to which it has been implemented and has evolved following its adoption. The results are confirming in that: the majority of recommendations have been implemented; the program has developed further; and is supported by ancillary student enrichment activities. Medical professionalism has been given prominence through all phases of the course. Nevertheless, challenges remain and particularly in the extent to which medical professionalism is taught and assessed in various clinical postings.

Keywords:

• Core
• medical education professionalism
• learning outcomes
• medicine

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Medical professionalism: Is a global term that expresses both medical and community expectations of medical practitioners. It includes a set of requirements that medical professionals maintain consistency in their health care practices including requirements for clinical competence; effective communication; a capacity to address ethical and legal issues which may arise; as well requiring them to exhibit moral values (or virtues) in relating to others. These values typically include ‘honesty’ and ‘integrity;’ ‘responsibility;’ ‘respect;’ ‘compassion;’ ‘empathy;’ and a capacity to work collaboratively. The literature on ‘medical professionalism’ is consistent in recommending that medical schools and professional colleges specify behaviours and attitudes, expressive of those moral values that are expected of their students, trainees and practitioners.

Notes

Acknowledgements

We are grateful to the following who participated in the Review: Dr Gene Chan, Phase 4 Director, YLLSOM; Consultant, Emergency Medicine Department, NUHS; Associate Professor Denise Goh Li Meng, Chair, Faculty Assessment Committee, YLLSoM; Senior Consultant, Department of Paediatrics NUHS, [DG]; Assistant Professor Calvin Ho, Phase 2 Coordinator, HeLP, Centre for Biomedical Ethics (CBmE), YLLSoM, [CH]; Associate Professor Alfred Kow, Assistant Dean (Education), YLLSOM, and Chairman Surgical Oncology NUHS; Professor Lau Tang Ching Vice-Dean (Education), YLLSOM, Senior Consultant, Division of Rheumatology, NUHS, [LTC]; Dr Lalit Radha Krishna, Phase 4 and 5 Coordinator, HeLP, CBmE, Senior Consultant Division of Palliative Medicine, National Cancer Centre, [LK]; Dr Darren Chua Hsiang Lim, assistant to Professor Lau Tang Ching, YLLSoM; Dr Victor Loh, Chair of the Communication Task Force, YLLSOM, Consultant, Division of Family Medicine YLLSoM, [VL]; Professor K Rajendran, previously Phase 1 Director, Department of Anatomy, YLLSoM, [KR]; Assistant Professor Voo Teck Chuan, Phase 1 Coordinator, HeLP, CBmE, YLLSoM; Ms. Jenn Ye, assistant to Associate Professor Alfred Kow, YLLSoM.

We acknowledge the following members of the Professionalism Task Force (2013–2014): Chair: Professor Paul Macneill, (then) CBmE, YLLSoM; Professor Hooi Shing Chuan, (then) Vice-Dean (Education), YLLSoM; Associate Professor Roy Joseph, (then) Patient-based Programme Director, YLLSoM; Dr Alfred Kow, Assistant Dean (Education), YLLSoM; Associate Professor Malcolm Mahadevan, Head, Department of Emergency Medicine, NUH; Dr Dujeepa D. Samarasekera, Director, Centre for Medical Education, YLLSoM; Professor Alastair Campbell, (then) Director, CBmE, YLLSoM; Dr Su Lin Lin, (then) Education Director, Department of Obstetrics & Gynaecology, YLLSoM; Associate Professor Tan Chay Hoon, Department of Pharmacology, YLLSoM; Professor Vathsala A, Nephrology Division Head, Department of Medicine, NUH; Executive Officer: Ms Ann Fong, (then) Senior Assistant Manager (Education), YLLSoM.

Notes

1 The Ministry of Health in Singapore, through a National Medical Undergraduate Curriculum Committee, now defines outcomes and minimum standards for all Singapore Medical Schools (Ministry of Health 2014).

2 The phase 1 HeLP course now includes a lecture and tutorial on ‘Professional identity formation’, and a lecture (at the end of that course) on ‘Integrating professionalism and ethics’. The Phase 2 HeLP course now includes a lecture on ‘Professionalism and ethics during clinical training years’.

3 Kevin Kawan. 2018. CNA; [accessed Aug 2019]. https://www.channelnewsasia.com/news/singapore/singhealth-health-system-hit-serious-cyberattack-pm-lee-target-10548318.

4 The project team was led by the Vice Dean (Education) [LTC], Phase 1 Coordinator [KR], and the Director of CenMED [DS].

5 Compassion, integrity and respect also draw from values adopted by doctors at the National University Hospital (a major teaching hospital for YLLSoM students): ‘teamwork’, ‘respect’, ‘integrity’, ‘compassion’, ‘excellence’, and ‘patient-centred’.

Additional information

Funding

The Professionalism Task Force Chair position (held by PM) was full time and funded for 12 months from discretionary funds within Yong Loo Lin School of Medicine (YLLSoM).

Notes on contributors

Paul Macneill

Paul Macneill, MA, LLB, PhD, Honorary Associate Professor in Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney. Previously: Visiting Professor, YLLSoM, National University of Singapore (2010–2014); Director of teaching of ethics and law in the Medical Faculty, University of New South Wales (1982–2006).

Roy Joseph

Roy Joseph, MBBS, MMed (Paeds), FRCPCH, FAMS, PBM, Associate Professor and Undergraduate Education Director, Centre for Biomedical Ethics, Associate Professor, Department of Paediatrics, Yong Loo Lin School of Medicine, Emeritus Consultant, Department of Neonatology, National University Health System and Chairman, National Medical Ethics Committee, Ministry of Health, Singapore.

Tamra Lysaght

Tamra Lysaght, PhD, Assistant Professor, Centre for Biomedical Ethics. Phase Director for the Health ethics, Law and Professionalism Programme, Yong Loo Lin School of Medicine, National University of Singapore.

Dujeepa D. Samarasekera

Dujeepa D. Samarasekera, MBBS, MHPE, FAMM, FAMS, FAMEE, FRCPE, Director, Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine and Senior Consultant at the Ministry of Health, Singapore.

Shing Chuan Hooi

Shing Chuan Hooi, MBBS, PhD, Professor, Department of Physiology, Yong Loo Lin School of Medicine and Chair, Medical Sciences Cluster, National University Health System. Previous Vice-Dean (Education) YLLSoM.