Teaching professionalism: a South African perspective

Abstract

Background: Incorporating the teaching and assessment of professionalism in an undergraduate medical curriculum is a challenging process. There are two components that require attention: the cognitive and the experiential. This article outlines how the School of Medicine at the University of Pretoria (UP), South Africa is addressing the teaching and assessment of professionalism.

Aims: To embed teaching and assessment of professionalism in a revised six-year undergraduate medical curriculum.

Method: This is a descriptive paper of a curriculum process that has stretched over a number of years. The eight principles regarding teaching professionalism provided by Cruess & Cruess () are used to reflect on the current strengths and weaknesses of teaching and assessing professionalism in the UP undergraduate medical curriculum.

 The cognitive component of the curriculum has been addressed by introducing a series of stage appropriate, contextualized assignments in each year of the curriculum. Faculty committee structures supported the development and implementation of this component. Students’ responses to an assignment on the influence of role models provided insight into how the experiential component impacts on their professional development.

Results: The teaching and assessment of the cognitive component were relatively easy to put in place. The challenge is to maintain this component. The experiential component appears to be much the same as it was prior to revision.

Conclusions: Our way forward is to expand the teaching and assessment of professionalism in the experiential component. We want to facilitate faculty to develop a charter on professionalism. The principles and commitments of the charter will underlie a white coat ceremony for undergraduates. These principles will also provide guidelines for role models in their supervision of experiential learning and can inform criteria for assessment. An assessment strategy to assess professionalism in the experiential component needs to be developed and implemented.

Introduction

The inculcation and assessment of medical students’ professionalism is a fairly recent development in medical education. Since professionalism forms an important aspect of medicine's contract with society, it is important that professionalism should be developed and assessed.

The very nature and values of medical professionalism have come under threat in recent years (Cohen 2006). In South Africa especially, a number of threats have been eroding medical professionalism, including reform in the health care system, fiscal constraints and the resultant conflicts of interest. Owing to these influences, and also the exodus of dedicated professional role models from public hospitals and medical schools in South Africa, it cannot be assumed that medical students will automatically acquire the desired attributes for their profession, without planned curriculum interventions.

‘Professionalism is conveyed towards patients by subtle signals of caring, understanding and probably most of all, competence’.1

A recent commentary by Cruess & Cruess (2006) prompted a reflection on the work done in one South African medical school's attempts to focus on the teaching of professionalism in an undergraduate medical curriculum. The cognitive and experiential components of the curriculum will be described and Cruess & Cruess’ eight principles will be used to structure the discussion.

Table

Practice points

The teaching and assessment of the cognitive component for developing professionalism in an undergraduate medical curriculum is relatively easy to put in place. Establishing the assessment of the experiential component remains a challenge. Role models play an important part in the development of professionalism and the positive impact of role models needs to be fostered.

Incorporating professionalism in a curriculum

Cruess & Cruess (2006) describe general principles for teaching professionalism which highlight

• the importance of strong institutional commitment to support the process;

• explicitly teaching the cognitive base as well as providing stage-appropriate experiential learning in an authentic context across the curriculum;

• the importance of role models, faculty buy-in and faculty development to maximize positive and minimize negative aspects of the informal or hidden curriculum;

• the assessment of both the cognitive base and behaviour, providing feedback and identifying lapses.

These principles are offered in the context of the seven principles outlined by the General Medical Council (GMC 2002) in the UK. Doctors should:

1. practise good standards of clinical care, practise within the limits of their competence and ensure that patients are not exposed to unnecessary risk;

2. maintain good medical practice, keeping themselves up-to-date and maintaining their skills;

3. develop and maintain respectful relationships with patients;

4. work effectively with their colleagues, demonstrating leadership skills and change management;

5. Develop the skills, attitudes and practices of competent teachers;

6. be honest; and

7. not allow their own health to put patients and others at risk.

In the USA professional organisations, such as the American Board of Internal Medicine (ABIM 2002) collaborating under the umbrella of Project Professionalism, have stated that professionalism includes numerous elements, among which, for example, are: altruism and respect for others, and additional humanistic qualities such as empathy, honour, integrity, ethical and moral standards, accountability, and excellence such as a commitment to lifelong learning and duty and advocacy.

In South Africa the outcomes for undergraduate medical education and training are described in a document published by the Health Professions Council of South Africa (HPCSA 1999) and include reference to objectives relating to professional attitude and professionalism. Graduates must have appropriate attitudes and behaviour patterns to ensure quality health care. Examples relating to these attitudes and behaviours include: respect for patients and colleagues, without prejudice; recognition of human and patients’ rights; an awareness of moral and ethical responsibilities; a desire to always ensure patient care of the highest possible quality; a positive approach to self-directed lifelong learning; an awareness of personal limitations and a willingness to seek help when necessary; and an acceptance of responsibility to contribute to the advancement of medical knowledge. It is further recommended that students’ behaviour and conduct should be exemplary and of such a nature that they will be regarded as role models in their communities. It is also expected of lecturers that they should always be aware of his or her function as a role model. The educational programme and training facilities of a medical school have to be accredited by the HPCSA.

The theoretical or cognitive base of professionalism should be explicitly taught and complemented with a process of socialization seated in authentic experience (Cohen 2006). In the socialization process role models play an important role (Maudsley, 2001; Joubert et al. 2006).

The University of Pretoria undergraduate medical curriculum

A revised integrated, problem-orientated, six-year curriculum was implemented in 1997 at the medical school of the University of Pretoria (UP). It consists of a series of 17 theoretical modules organized around body systems to promote vertical integration of curriculum outcomes, followed by clinical rotations during the last 18 months. Students are selected into the programme after completing their grade 12 schooling. The annual intake is in the order of 210 students. Students graduate after six years and then complete a two-year internship, followed by a year of compulsory community service before they can register with the HPCSA to practice independently as a medical doctor. During their internship they work under the supervision of clinicians and registrars (post-graduate students undergoing specialist training) in a public health service setting.

Over and above the curriculum components described above, the concept of Golden Threads (GTs) is used to denote nine generic and professional skills which do not stand alone as modules but are woven into the fabric of the six-year learning programme.

The nine Golden Threads are the following:

• Interpersonal skills

• Group and team work

• Professional attitudes

• Bioethics

• Problem solving and critical thinking

• Research-based clinical practice

• Health and the law

• Economy and health

• Epidemiological approach to health

A committee was constituted for each of the GTs to develop and institute appropriate curriculum activities across the curriculum. Since 2002 the Professional Attitude Development and Assessment Committee (PADAC) was responsible to devise strategies for weaving a golden thread of professional attitudes in the curriculum.

The aim of the committee was to

• provide curriculum inputs to explicitly teach and assess the cognitive base of professionalism.

• create opportunities for students to reflect on professionalism throughout the curriculum.

• stimulate and encourage students to be aware of and differentiate between the professional/unprofessional behaviour of peers, colleagues and role models.

Principles for teaching professionalism in undergraduate medical training

The eight principles regarding teaching professionalism provided by Cruess & Cruess (2006) are used to reflect on the current strengths and weaknesses of teaching and assessing professionalism in the UP undergraduate medical curriculum.

Institutional support

At UP the Undergraduate Programme Committee (UPC) supports the inclusion of teaching and assessing the theoretical component related to professional development, albeit with limited time allocation in the curriculum. However, the influence of the UPC is limited in the implementation and assessment of teaching related to professionalism in the experiential component in clinical settings.

The cognitive base

We agree with Cruess and Cruess that the theoretical component must be taught. This was addressed over a period of five years by introducing a longitudinal series of assignments to form a logical progression in continuously sensitizing students to professional attitudes and professionalism. Each year the students complete an assignment with a different focus on professional attitudes and professionalism. The following topics are thus addressed in the theoretical component of the curriculum.

• 1st year

  • Reflect on the desirable attitudes they want to acquire or display as a General Practitioner.

  • Reflect on the role of the doctor in the professional health care team.

• 2nd year

  • Reflect on changes in professional attitude toward the patient due to the impact of workload on health care workers.

  • Gain insight into their own personality traits by completing a personality questionnaire and then reflect on personal strengths and weaknesses and how these can best be applied in group work and clinical work.

  • Reflect on different attitudes and behaviours displayed by professionals.

• 3rd year

  • Reflect on the causes of uncaring attitudes and propose strategies to prevent unprofessional attitudes.

• 4th year

  • Reflect on compassion fatigue.

• 5th year

  • Reflect on different aspects of Professionalism.

Each year, over a period of 5 years, the following topics were addressed in the fifth year assignment:

• 2002 Reflect on and respond to the Physician Charter (ABIM 2002) with respect to its relevance to the South African context (van Rooyen 2004).

• 2003 Define professionalism and describe its attributes and qualities.

• 2004 Develop and describe a tool for the assessment of students’ professionalism. (van Rooyen and Treadwell 2007)

• 2005 Develop and describe a model for the rehabilitation of students that have been identified as being unprofessional.

• 2006 Reflect on the influence role models have on the development of professionalism.

The above assignments were assessed using a rubric as a marking guide. Assignments were allocated a rating of not yet adequate, adequate or excellent. A rating of adequate is needed to fulfill course requirements.

In their assignments1 students express different opinions on whether professionalism can be taught or not. Some felt that a basic values system influenced by role models such as parents and teachers should already be in place before the student enters medical school. These values form a foundation for the development of professionalism.

‘Standards for professional and ethical conduct are being addressed within the formal curriculum of our medical school but must be re-enforced by example of the faculty and staff.’

‘I cannot be taught this aspect of medicine by any textbook. I need to go out there to apply and experience these principles of professionalism in order for me to constantly improve and grow as a professional.’

‘The environment in which our training as medical students takes place serves in many ways as the incubator of professionalism.’

Experiential learning

Students have early exposure to patients and from the fourth year onwards, continuous exposure to patients. In their assignments our fifth year students have described a wide variety of clinical experiences, good and bad, that relate to their development of professionalism.

‘Essentially, professionalism is the stage upon which members of a trade practice their skill.’

During their experiential training students are mainly exposed to the public sector during their rotations, with a brief experience of the private sector during their preceptorship and in some cases the elective.

In South Africa there are two very different medical systems, catering for a wide variety of patients covering the whole spectrum of social welfare. On one hand there is the public sector, with free services to pregnant woman, children under six and people on social pensions. This system is overloaded, with overworked and compassion fatigued doctors who have to cope with limited resources and time, trying to provide the best possible service to the biggest part of the population, especially in more rural areas. On the other hand there is the private sector where some patients belong to medical aid schemes. Here resources are readily available, but doctors are becoming increasingly frustrated because control over the management of patients is being taken out of their hands by medical schemes and other role players who, for instance, prescribe what special investigations may be done, how many consultations a patients is allowed per annum and/or what medicines a doctor may prescribe.

‘Most people in the community are under the impression that they receive an inferior level of care if they go to a government hospital for a consultation as opposed to that in the private hospitals. Private hospitals have so much easy access to the best and most expensive medication and more advanced equipment and it is readily available to their patients. On the other hand at a government hospital there is usually a long waiting list for an essential investigatory test. However they are ill informed as many of the professors and heads of departments that are currently working at the government institutions and that are responsible for our education are highly regarded by their peers, choose to humble themselves and give something back to the community that needs them and that they in turn love to serve. These highly recognized members of the medical fraternity could be else where making large sums of money yet they consciously forfeit that for a more rewarding experience helping those in need who can’t go anywhere else. This is to me and my peers such an inspiration.’

However, another student wryly comments

‘The impression I get is that you have to have a certain amount of money in order for you to get quality care in this country. This is very disappointing for me.’

The first exposure students have to patients is in the second semester of their first year, when they interview four hospital patients during the first week, and then meet patients from the community and private sector during the last three weeks of the semester. They are given guidelines as to what information is required and a few questions they can ask the patients. They are then challenged to reflect on the good attributes a doctor needs to have, their role in the medical team and also the impact that the first encounter with a patient had on them personally. This is the first in the series of longitudinal assignments focusing on professionalism.

In the beginning of the second year role plays and simulated patients are used to teach interpersonal and communication skills and then at the end of the year, patient interviews, a movie and team work exercises challenge them to reflect on professional behaviour and attitudes. In the third year they get more and more patient contact and they have to choose a family with whom they will form a longterm relationship to do the longitudinal family attachment. They visit this family during each module with specific tasks and actions that relate to the module, for example, in the cardiovascular module they have to take the BP of every family member. Students get the opportunity to choose an elective at the end of their third year, when they spend time in an academic department of their choice for a month.

In the fourth year and the first semester of the fifth year, the students have clinical rotations in the mornings in discipline specific departments and in the afternoons the whole class attends theoretical lectures. The clinical rotations include practical work in the wards, ward rounds and discussions at the patient's bedside, and small group discussions. At the end of the fourth year they do a two-week preceptorship where they spend time in a practice seeing patients everyday with a doctor. From the second semester of the fifth year, until the end of their sixth year, they spend the whole day with a discipline specific department, taking some responsibilities in the team they work in. They also do after hours work with that team.

Continuity

Attempts have been made to ensure continuous inputs on professionalism throughout the curriculum. One strategy was to use the concept of Golden Threads (GTs) described above. The longitudinal series of assignments described in the section on the cognitive base, addressed the GTs relating to personal and professional development. Using the concept of GTs to integrate the teaching and assessment of professional development in the curriculum has its advantages and disadvantages. The advantage is to expose students to stage appropriate, contextualized inputs continuously throughout the curriculum. A disadvantage is that the threads may unravel and components then fall through the gaps. For example, the assignments in year 3 and year 4 have recently fallen away due to two key members of staff leaving.

Role modeling

Role models play an important part in the professional socialization of medical students. Students learn from both positive and negative role models.

‘So I have met people who will remain my role models forever and ever and for that I am grateful! As for all the doctors who made me feel ashamed to be associated with them, they have taught me a lesson that I will carry with me for years to come and that is never be or act like they do!’

Wright et al. (1998) investigated the characteristics of physicians identified as excellent role models. They found that physicians who spend substantial amounts of time with trainees, who have had training in teaching, and who build positive relationships with patients and demonstrate to trainees the importance of a comprehensive approach to patient care are most likely to be identified as excellent role models. As many of these attributes represent behaviour that can be modified the authors concluded that providing advice and training could help more physicians to become excellent role models.

Szauter et al. (2003) found that students had observed the following transgressions by role models in their faculty:

• Making derogatory comment about other services.

• Making derogatory comments about a patient or the patient's family.

• Using disrespectful terminology in the description of patients.

• Inappropriately withholding of information or intentionally giving incorrect information to a patient.

• Discussing confidential information in an inappropriate setting.

• Treating patients differently because of the patient's financial status, ethnic background, sexual or religious preferences.

• Treating non-physician healthcare workers in a disrespectful or inappropriate manner.

It would appear from UP students’ assignments1 that they are also exposed to both positive role models and to the types of transgressions listed above.

Although there were some negative instances, it would appear that on the whole that UP students encounter many positive role models during their preceptorship in the private sector. These doctors were perceived by the students as working according to the bio-psycho-social approach practicing medicine holistically, treating patients with respect, taking pride in their work, continuously updating their knowledge and often providing a service to poor patients in their community. Students observed that these doctor's patients were often satisfied and loyal to the doctor.

However, students spend most of their clinical time in public sector settings where a variety of role models are encountered.

Students describe instances of doctors being derogatory towards patients and not respecting the patient's dignity.

‘The typical ward round at an academic hospital consists of a doctor in charge, consultants, registrars, 6th, 5th and 4th year medical students and maybe a nurse; this encompasses about 10 people, excluding the patient. The doctor stops at a patient's bed, asks for a quick presentation or update of the patient's predicament, everyone ogles, touches, feels and admires the abnormality, maybe a short discussion (often with their backs facing the patient) about the patient's treatment, prognosis etc and then moves onto the next bed. Most doctors do not introduce themselves to the patient or ask the patient how he or she is feeling.’

Students note the importance of good professional relationships amongst colleagues.

‘Some of the doctors I worked with had an excellent way of showing respect to the nursing staff. This in turn had a positive effect on the way the nursing staff looked after the patients. If a good relationship doesn’t exist between the doctor and the nursing staff, the patient is the one who ultimately suffers.’

Students also find themselves on the receiving end of derogatory behaviour.

‘To maintain composure in difficult interactions with colleagues is one of the fundamental principles of professionalism. Is shouting at students for the slightest thing maintaining composure? I can’t help to think that in real difficult situations that all control will be lost …. I once asked a question and the answer I got is ‘You tell me, and if you do not know, I am not a textbook.’

Some students comment on the effect that the difficulties experienced in the public sector have on health care workers’ professional behaviour.

‘Most often students and maybe some doctors or other health professionals get discouraged when the road changes from tar to dirt to corrugation and potholes, that is when rattles are picked up and the quality of the vehicle is tested.’

Another student comments

‘Professionalism does poorly in an always stressful, always unpleasant environment, much like plants do poorly in a dry, dark room.’

Progress is being made with implementing social welfare in South Africa and resources are allocated to do most good to most people. It still remains difficult to distribute resources fairly, especially for terminally ill and chronically ill patients and students see doctors making tough decisions when a patient is no longer a candidate for treatment. Doctors take strain when they have to convey this difficult message to the patient and sometimes this responsibility is delegated to a junior member of staff, or even a student. One student notes

‘Doctors in the government and academic settings are so pushed for time and have so many patients to diagnose and treat in one day that the basic principles of respect and listening and counseling patients are neglected. Doctors justify this by arguing that they are getting their ‘problem’ fixed so why should they bother by listening to their meaningless concerns.’

Examples of positive role models maintaining a caring attitude towards patients under difficult circumstances are also given.

‘But the examples that easily stand with head and shoulders above the rest are these unplanned golden-pearls I received from my equals during our daily studies! … my colleague turned tiredly to me and complained about the heavy workload …. when we got to the patient she turned slowly towards him and greeted him with a voice bubbling with pleasantness and the biggest smile she could muster.’

‘And I must say that some doctors have a way with words and with patients.’

Health care workers are observed being careless in terms of patient confidentiality.

‘There are instances where some doctors, especially sisters and nurses, don’t even bother to at least try to be confidential about their patient's information. You’ll find them divulging personal and confidential information about patients to anyone who is willing to listen!’

‘We observed two nursing sisters making casual comments about a patient in a lift.’

Patient autonomy can be disrespected by not fully informing the patient. In a multi-lingual society (South Africa has 11 official languages) language can be a barrier to informing the patient and getting informed consent.

‘I have encountered doctors/nurses who do not feel the need, or do not have the time, to explain all the information to the patient. The rationale, as explained by them, … is a lack of time, poor educational level of the patient and language difficulties. Thus the disease is treated and not the patient.’

Examples of respecting and disrespecting patient autonomy are cited. In a country with a high prevalence of HIV/AIDS students often witness patients being informed about their HIV status. Students describe instances where breaking bad news is done well and badly.

‘I was very impressed with the doctor who told the patient she is HIV positive and enlightened and empowered her about the disease with knowledge and how to live with a positive attitude.’

‘It happens so often it never shocks me any more to see patients being told about their HIV positive status in an open ward full of people without closing the cubicle or even providing the post testing counselling.’

Although students gave many examples of good role models, unfortunately examples of undesirable role models abound. Maheux et al. (2000) found in a survey that over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models. They concluded that an unacceptably large number of medical students are taught by physicians who seem to lack compassion and caring in their interactions with patients. Feudtner et al. (1994) found that 98% of clinical students surveyed had heard physicians refer derogatorily to patients and 54% of the students felt like accomplices. This sentiment is echoed in a comment by one of the UP students:

‘I was unaware at that stage that as students we could report any injustice we had observed, and thus I too was accountable for perpetuating this dehumanizing act as I did not report this incident or rather was ignorant of what to do.’

Faculty development

A recent development at UP is to involve faculty in drawing up our own charter of professionalism. This could serve as a vehicle to sensitize the teaching staff of the importance of the development of professionalism for medical students. There are also plans to initiate a white coat ceremony for which we have to draw up our own declaration that students will declare, based on the charter.

Internationally the white coat ceremony is supported to encourage professional development. A common appeal is to the good will felt at the event. Our own declaration must first be discussed and approved by the key players. This declaration will by no means, be a ‘moral code’ but a statement of intent. We are aware of the criticism (Veatch, 2002; Huber 2003) of the white coat ceremony and will take it into consideration when we decide on the declaration, as well as the advice of Sritharan et al. (2001), not to discriminate on religious, cultural, ethnic and national identities. The declaration will be based on the fact that medical professionalism has an evolving characteristic pattern of balancing its values within a reflective equilibrium and this pattern is a collective one, and reflection is both individual and across the profession. There are certain values and responsibilities in medicine that are in principle not negotiable because they represent medicine's characteristic pattern of organizing values.

Assessment

The assessment of the cognitive component is in place. The longitudinal series of assignments are assessed using a rubric and a rating of adequate is needed to fulfill course requirements.

At the time of implementing the revised curriculum an instrument was developed for assessing professional attitudes. Faculty participated in a series of work sessions to identify desirable behaviours which were refined and matched to professional values to provide the criteria for assessment. The instrument consists of seven assessment criteria for the clinical approach and six criteria for professional behaviour: Respect; Empathy; Interpersonal relations; Maturity; Integrity and Responsibility. Each criteria is rated on a nine-point Likert scale. The instrument was intended to monitor the development of students’ professionalism during the fourth and fifth years through self-assessment, peer and supervisor assessment. Each student would compile a portfolio through continuous assessment and receive feedback. Currently this assessment activity has only been established during one of the clinical rotations. A renewed effort needs to be made to sensitize clinical staff regarding the importance of monitoring students’ professional development and to get their buy-in to further implement the plan for students to compile a portfolio.

Formalizing the teaching and assessment of professional behaviour in the experiential part of the curriculum remains a challenge. We do not yet have a formal mechanism for identifying or remediating unprofessional behaviour of students. A professionalism project is being launched to address these issues specifically. A system of assessment needs to be developed and there are a number of both formative and summative assessment methods which can be considered (Cohen, 2006).

Environment

As Cruess and Cruess point out the ‘formal’ curriculum is juxtaposed with an ‘informal’ and ‘hidden’ curriculum. The ‘formal’ curriculum is explicitly stated in the institution's mission and the course outcomes. The ‘informal’ curriculum is at work in the unscripted, unplanned and highly interpersonal forms of teaching and learning that take place among and between faculty and students. The ‘hidden’ curriculum represents organizational structure and cultural influences. The ‘informal’ and ‘hidden’ curricula have a profound, sometimes positive, sometimes negative, influence on role models and the environment in which students develop as professionals.

In 2001/2002 the last cohort of UP students graduating from the traditional curriculum and the first cohort of students graduating from the revised curriculum were asked to describe their development of ‘soft skills’ and their personal and professional growth. Students’ views on their professional development between the traditional and revised curriculum were very similar, except that students from the revised curriculum felt more prepared through the increased teaching and training efforts. This relates to the more explicit teaching of the theoretical/cognitive component. The perceptions relating to the environment in which experiential learning takes place were very similar. (du Preez et al. 2005; Bergh et al. 2006) Students’ perceptions of role models and the experiential learning environment as reflected in their more recent assignments on professionalism seem to indicate that although the cognitive component of the curriculum has improved, a renewed effort needs to be made to improve teaching and assessment of the development of professionalism in the experiential component of the curriculum.

Conclusions

Incorporating professionalism in the curriculum is an ongoing process and although much remains to be done, one must also acknowledge that much has been achieved. Both staff and students are more sensitised to issues relating to professionalism.

The cognitive component was relatively easy to put in place. Institutional support for the concept of weaving Golden Threads (GTs) into the fabric of the curriculum was provided by faculty committee structures (e.g. UPC, PADAC). The longitudinal series of assignments provide stage appropriate, contextualised opportunities for student to reflect on professionalism and their own professional growth. The assignments are assessed and form part of course requirements to pass. A disadvantage of the GTs concept is that the threads may unravel and components fall through the gaps. For example, the assignments in year 3 and 4 have recently fallen away due to two key members of staff leaving. Up to now this problem has not been solved due to staff shortages.

The environment in which most of the experiential training takes place (public sector) largely lacks a culture of professionalism due to high workload and low morale. It remains a challenge to get the commitment of relevant staff to pull the GTs from the cognitive component through to the experiential component. During their rotations the students spend a lot of time with the registrars and less time with consultants. The registrars in our context are important role models (Joubert et al. 2006) and are a good target population to try and involve more in sensitizing students regarding professionalism, helping students to reflect, providing feedback and to assess professional behaviour. Faculty development programmes need to be developed to achieve this.

Although an instrument was developed to assess professionalism in the experiential component this has only been implemented in one department. Assessment of professionalism does not carry much weight in the final pass/fail decision. There is currently no formal mechanism for identifying students with unprofessional behaviour early in the curriculum and no formal remediation programme in place.

Our way forward is to facilitate faculty to develop our own charter on professionalism. The principles and commitments of the charter will underlie a white coat ceremony for undergraduates. The principles will also provide guidelines for role models in their supervision of experiential learning and can inform criteria for assessment. An assessment strategy to assess professionalism in the experiential component needs to be developed and implemented.

Acknowledgements

The authors would like to thank Professor Ina Treadwell and Ms Isobel van Huyssteen for their input and support.

Notes

Additional information

Notes on contributors

R. R. Du Preez

RENATA DU PREEZ is a psychiatrist working in the Department of Psychiatry at the University of Pretoria. She is the chairperson of the Professional Attitude Development and Assessment Committee. She is involved with the development of teaching and assessment of professional attitudes in the undergraduate medical curriculum.

G. E. Pickworth

GLYNIS PICKWORTH is an education adviser working at the Faculty of Health Sciences at the University of Pretoria.

M. Van Rooyen

MARIETJIE VAN ROOYEN is a family physician working in the Department of Family Medicine at the University of Pretoria. She is actively involved in the teaching and assessment of activities related to professionalism in the undergraduate medical curriculum.

Notes

1. The students’ quotes used in this article are taken from students’ scripts submitted for an assignment on professionalism and role models completed by the 2006 fifth year medical students. Ethical approval was obtained from the Ethics Committee of the Faculty of Health Sciences, University of Pretoria, to use the data.