Shaping professionalism in pre-clinical medical students: Professionalism and the practice of medicine

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Practice points

The teaching and assessment of professionalism should be consistent and longitudinal. Developing a professionalism curriculum that integrates learning with experience should be done in the context of theoretical learning constructs. Faculty mentors can serve the dual purpose of role modelling and providing guidance in the development of medical students as professionals. Assessment of learners includes self, peer and faculty assessment as well as reflection, and portfolios to mirror assessment methods in professional practice

Table 1.  Course goals

• Develop and promote professionalism, ethics, empathy, reflection, cultural competence, communication skills and collaborative learning.

• Create and maintain community and a social context to provide identity and facilitate learning.

• Provide professional role models for students to emulate.

• Prepare students to work collaboratively and increase their small group skills.

• Provide students with an opportunity to build professional identity.

• Encourage students in their learning, reflection, peer and self-evaluation.

• Introduce students to the nature of professionalism.

• Provide opportunities for students to gain skills and demonstrate competence in the areas of communication, social and community context of health  care, ethical judgment, self-awareness, self-care and personal growth, professionalism and life-long learning.

• Provide opportunities for students to gain skills and demonstrate competence in the areas of communication, social and community context of health  care, ethical judgement, self-awareness, self-care and personal growth, professionalism and life-long learning.

• Encourage students to demonstrate self-initiative and leadership skills when leading and presenting to the group.

• Prepare students for transition to Year 3.

Table 2.  Curricular themes

Professionalism

• Beginning our professional journey: symbol & ritual

• Professionalism in action: threats to professionalism

• Physician well-being

• Nuts & bolts of medical practice

• Physician satisfaction and physician impairment

Cultural competence

• Introduction to culture and its role in medicine

• Screening the soul: spirituality in medicine

• Herbs, vitamins, and botanicals

• Integrative medicine: CAM practitioners

• Health care disparities

• Gang cultures of East Los Angeles

• Healthcare for LGBTQ patients

• Patients with substance abuse

• Effective use of medical interpreters

• Caring for patients with disabilities

• The physician's role in community advocacy

• Community diagnosis

Health policy

• Healthcare legislation

• Paying for healthcare

• Public health

Ethics

• Introduction to ethical principles

• Principles of ethical decision-making

• Ethical decision-making: when values clash

• End of life-treatment ethics

Empathy

• The art of medicine

• Narrative medicine

Group process

• Sharing our stories

• Effective teamwork

Table 3.  A typical session

Professionalism I: Beginning our professional journey: Symbol and ritual

Faculty Resource: Dr Reilly

Session goals:

• Introduce the importance of professionalism as part of physician training.

• Discuss the white coat and its history as a symbol of their medical journey.

• Study the relevance of the Hippocratic Oath to modern medicine and review the KSOM Code of Professional Behaviour.

• Have students explored their commitment to the medical profession and the professional qualities they hope to embody as a physician.

Session outcomes:

By the end of the session students will be able to:

• Discuss the philosophy of professionalism at KSOM and in the profession of Medicine.

• Describe ways to exhibit attributes of professionalism in their daily lives.

• Develop their personal Hippocratic Oath as it relates to their own concept of medical professionalism.

• Self-reflect on their personal medical journey and their expectations of themselves, their classmates and their medical training as part of this professional development.

Pre-session assignment:

Students are to write their own Hippocratic Oath. Each individual student's one-page oath is to be e-mailed to both PPM mentors.

Pre-session readings:

(1) KSOM Code of Professional Behaviour

(2) The abridged Hippocratic Oath

Discussion:

The necessity to teach professionalism in the medical school curriculum has been the subject of numerous recent publications. The purpose of this session is to specifically introduce the students to the concept of what is meant by a profession, describe what behaviours are expected of medical professionals, to provide a forum and opportunity for the student to reflect on what brought them to medical school and on what kind of personal and professional attributes they hope to embody as a physician. Specifically, the issue of how they will behave in their professional community will be addressed. They will discuss the symbols and rituals they have just experienced as part of the White Coat Ceremony as part of their professional development.

Introduction to professionalism—Dr Reilly—Lecture hall

Dr Reilly will begin a discussion of the medical journey and the symbols and rituals that are part of that journey beginning with the white coat. She will also introduce the concept of professionalism and its significance in their medical training and daily lives. The session will utilize clips from ‘Patch Adams’ and ‘The Doctor’

Case discussion on professionalism and the White Coat – Learning community

Potential questions to start the discussion include:

• Were Jack McKee MD, and/or Patch Adams good examples of professional behaviour? Why or why not?

• How does your own Hippocratic Oath compare with the behaviour demonstrated by the doctors in the movie?

• What personal and professional attributes will you cultivate to enhance professional behaviour?

• What will be your biggest challenge in cultivating a professional identity?

• How do groups cultivate a professional identity?

• How will this learning community impact the professional development of its members?

Learning community code of conduct – Small groups in the learning community

Students will work together in their small groups to construct a suggested code of conduct for their learning community. Utilizing discussion, while referring to the KSOM Code of Professional Behaviour, students will develop a set of standards for behaviour in the learning community. A leader from each small group will share their suggestions with the entire learning community for synthesis into a working document.

Learning community code of conduct – Learning community

Group leaders from each small group will present their groups recommendations for the learning community code of conduct. Items of agreement should be solidified, differing issues debated and compromise achieved. Students should be reminded that this is a preliminary discussion, and that the process is expected to continue outside of PPM. It is expected that students will use independent time to meet as a group to complete this task. The outcome of this assignment is a code of behaviour for their learning community for the next 2 years. It should be a document that everyone is willing to abide.

Portfolio: (1) Individual Hippocratic Oath. (2) The learning community Code of Behaviour will be posted in the MDL and included in each student's portfolio.

Table 4.  Table of contents of Year 1 portfolio

Fall Semester
Portfolio Item	Session*
Autobiography	2
Individual Hippocratic Oath document (pre-session assignment)	3
MDL oath (final version)	4
Lifestyle Wheels	5
Health contract (signed and dated)	5
Community Diagnosis (pre-session assignment)	6
Myers–Briggs Personality Inventory	8
Student writing – individual spiritual assessment and reflection using HOPE model (pre-session assignment)	10
Self-evaluation exercise	11
Self-assessment assignment	11
MSPE Advisory Committee Professionalism Assessment Form (copy of completed evaluation submitted for ICM)
Spring Semester
Portfolio Item	Session**
Student writings – narrative writing	14
Self-reflection: cultural competence	14
Student writings – ethical dilemma (pre-session assignment)	17
Self-reflection: ethics	18
Self-evaluation exercise	19
Self-assessment assignment	19
Curriculum vita	19

Notes: *The portfolio will be reviewed with students at their mid-year evaluation session.

**The portfolio will be reviewed with the student at their year end evaluation session.

Table 5.  Educational program objectives and learner outcome objectives

Professionalism – Demonstrate altruism in interactions with patients, colleagues, faculty and staff. Act with honour and integrity in professional and personal life. Demonstrate caring and compassion for patients and for members of the healthcare team. Respect patients’ rights and wishes, and act in a respectful manner towards faculty, colleagues and staff. Act responsibly in his/her professional and personal life. Pursue excellence in scholarship, assuming responsibility for addressing gaps in knowledge. Model good leadership in interactions with others, and foster others’ development.	• Demonstrates reliability, dependability, integrity, courtesy and self-discipline in the classroom and with their small group in all learning settings.	• Recognizes and can describe own role and the roles of other members of the team.
• Demonstrates emotional maturity, recognizes issues in interaction and is able to appropriately resolve tensions and conflicts.	• Recognizes and can discuss with knowledge legal and ethical issues in health policies and in own patient care experiences.
• Demonstrates leadership in both large and small group activities.	• Demonstrates the pursuit of excellence in individual activities in PPM and in those of the group.
	• Demonstrates leadership in both large and small group activities.