The challenge of teaching professionalism.
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The medical profession has been conscious of all the changes happening in society in the last quarter of the 20th century and has tried to cope with it. Numerous criticisms about the profession and its professionals have stimulated a revision of the professional's behaviour and professionalism. The Royal College of Physicians and Surgeons of Canada has launched its own proposal under the name of CanMEDS 2000. Among the revised roles and competences one find professionalism. This theme is at the heart of our profession since the early days of the 20th century when medicine became a modern profession. Responsibility for the patient remains fundamental for any doctor but, today, society expects more accountability from the medical profession. We have the obligation to educate our residents not only for healing and caring of patients but also for active participation in managing the healthcare system. In this paper, we examine this renewed post-modern professionalism. My intention is to propose a visual approach for the teaching of professionalism. (+info)
Teaching and learning of professionalism in medical schools.
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Concerns about professionalism in medicine have made necessary the explicit teaching and learning of ethics, professionalism and personal development. The noble profession of medicine, taken up as a "calling" by those who are expected to put the needs of the patient above their own, appears to have become a fees-for-service business model and trade. Parental expectations, the diminishing sense of responsibility in teachers, lack of role models, technological advancements, sub-specialisation and third-party involvement in the healthcare delivery system have been identified as reasons for these concerns. The General Medical Council in the United Kingdom, and other professional bodies in both Europe and the Americas, have emphasised the need to enhance the teaching and learning of professionalism in medical schools, particularly the development of good attitudes, appropriate and competent skills, and the inculcation of a value system that reflects the tenets of professionalism in medicine. The medical curriculum will need to be scrutinised so as to introduce the subject of professionalism at all levels of training and education. Barriers to learning professionalism have been identified and students need to be equipped to resolve conflicts and to put the needs of others above their own. (+info)
Standards and revalidation or recertification.
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Patients want doctors who are competent, respectful, honest and able to communicate with them. This is patient-centred professionalism. In the United Kingdom, it is being embedded into practice by the General Medical Council (GMC) through medical regulation in a partnership between the public and doctors. The foundation is a national code of professional standards - Good Medical Practice - that has been tied to medical licensure to secure doctors' continuing compliance whilst they are in active practice. The revalidation of a doctor's license to practise is the means of achieving such compliance. Revalidation requires that specialists and general practitioners must be able to demonstrate - on a regular basis - that they are keeping themselves up to date and remain fit to practise in their chosen field. It begins in April 2005. For revalidation, doctors' performance, conduct and health will be assessed against the headings of Good Medical Practice. Doctors will collect a folder of illustrative evidence that will form the basis of an annual appraisal carried out at the workplace by an appropriately trained colleague. The results of these annual appraisals will be submitted to the GMC for a revalidation decision every 5 years. Where doctors' performance or conduct gives cause for concern, they may have to undergo a further searching assessment under the GMC's Fitness to Practise Procedures. Under these procedures the GMC can order a doctor to retrain or, if circumstances warrant it, to stop practising. (+info)
Do online information retrieval systems help experienced clinicians answer clinical questions?
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OBJECTIVE: To assess the impact of clinicians' use of an online information retrieval system on their performance in answering clinical questions. DESIGN: Pre-/post-intervention experimental design. MEASUREMENTS: In a computer laboratory, 75 clinicians (26 hospital-based doctors, 18 family practitioners, and 31 clinical nurse consultants) provided 600 answers to eight clinical scenarios before and after the use of an online information retrieval system. We examined the proportion of correct answers pre- and post-intervention, direction of change in answers, and differences between professional groups. RESULTS: System use resulted in a 21% improvement in clinicians' answers, from 29% (95% confidence interval [CI] 25.4-32.6) correct pre- to 50% (95% CI 46.0-54.0) post-system use. In 33% (95% CI 29.1-36.9) answers were changed from incorrect to correct. In 21% (95% CI 17.1-23.9) correct pre-test answers were supported by evidence found using the system, and in 7% (95% CI 4.9-9.1) correct pre-test answers were changed incorrectly. For 40% (35.4-43.6) of scenarios, incorrect pre-test answers were not rectified following system use. Despite significant differences in professional groups' pre-test scores [family practitioners: 41% (95% CI 33.0-49.0), hospital doctors: 35% (95% CI 28.5-41.2), and clinical nurse consultants: 17% (95% CI 12.3-21.7; chi(2) = 29.0, df = 2, p < 0.01)], there was no difference in post-test scores. (chi(2) = 2.6, df = 2, p = 0.73). CONCLUSIONS: The use of an online information retrieval system was associated with a significant improvement in the quality of answers provided by clinicians to typical clinical problems. In a small proportion of cases, use of the system produced errors. While there was variation in the performance of clinical groups when answering questions unaided, performance did not differ significantly following system use. Online information retrieval systems can be an effective tool in improving the accuracy of clinicians' answers to clinical questions. (+info)
Public Health Information Network--improving early detection by using a standards-based approach to connecting public health and clinical medicine.
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Public health departments and their clinical partners are moving ahead rapidly to implement systems for early detection of disease outbreaks. In the urgency to develop useful early detection systems, information systems must adhere to certain standards to facilitate sustainable, real-time delivery of important data and to make data available to the public health partners who verify, investigate, and respond to outbreaks. To ensure this crucial interoperability, all information systems supported by federal funding for state and local preparedness capacity are required to adhere to the Public Health Information Network standards. (+info)
Treatment of multiple sclerosis: beyond the NICE guidelines.
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Multiple sclerosis (MS) is a common, disabling neurological condition whose pathogenesis is not clearly understood. Although current treatment recommendations assume an immunopathogenic disease mechanism, MS may not be an autoimmune disorder. Long-term immunological therapy for MS is in our view an untested approach, guided by uncritical acceptance of data from drug trials. We do not believe that there is convincing evidence that any of these immune-based treatments prevents long-term disease progression, or has much effect on common disabilities such as fatigue, pain, depression and cognitive impairment. The recent recommendations of the National Institute of Clinical Excellence did not address important issues regarding disease modification, management of paroxysmal symptoms and the likely therapeutic candidates for future treatment trials. We discuss treatment options for MS beyond the NICE guidelines. (+info)
Clinicians' management strategies for patients with dyspepsia: a qualitative approach.
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BACKGROUND: Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own. METHODS: Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted. RESULTS: For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced. CONCLUSION: Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate evidence so that clinicians are able to interpret and implement it in practice. Of particular significance is that scientific evidence leads to an evidence-based care which is effective clinical practice and to the promotion of health from the perspective of the patient, together with cost-effectiveness as a priority. (+info)
Early practical experience and the social responsiveness of clinical education: systematic review.
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OBJECTIVES: To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence. DESIGN: A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. DATA SOURCES: Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. SELECTION OF STUDIES: All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. RESULTS: Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations. CONCLUSION: Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums. (+info)