IM Sechenov First Moscow State Medical UniversityTempus IV 159328 - April 2012
IIIrd International Conference
Education in MedicineSystem of Lifelong Training for Medical
Schools Teachers
Professionalization of Medical Students
Pr Sylvain MeurisFaculté de Médecine
Université Libre de Bruxelles
Profession : origin of termEnglish Russian French
Profession профессия ProfessionProfessor профессор Professeur
Professionalism профессионализм
Professionnalisme
Same Latin Root
- pro & fateor => To confess before (public)
- profiteor => To proclaim something publicly
What physicians are professing ?
Physicians declare publicly two things To be competent to help the patients To have the patient’s best interests in
mind ‘Profession’ or declaration of
commitment to an ideal to which he should conform
What physicians are professing ?
Since centuries, physicians profess in two ways: The public act of ‘oath taking’
moment of transition to become a professional (≠ medical degree)
The doctor-patient relationship This dialog represents an every
day tacit commitment
Public expectation from practitioner “… nothing is more estimable than a
physician who, having studied nature from his youth, knows the properties of the human body, the diseases which assail it, the remedies which will benefit it, exercises his art with caution, and pays equal attention to the rich and
the poor.”Voltaire (1694-1778) Bleeding and enema were the most
prescribed therapeutic at this time !!!
What qualities are expected today from a physician ? From patients point of view Reliable Accessible Dedicated Honest Accountable Respect patient’s autonomy Respect patient’s
confidentiality Non-judgemental Compassionate Confident Composed
From practitioners point of view
Knowledge Altruism Accountability Respect Integrity Submission to an ethical
code Lifelong learning Honesty Compassion Excellence Self regulation
Are physicians attitudes & behavior always ideal
Plato (428-347 BC) described paradoxal types of doctor-patient relationships
(1) Medicine for 'free citizens’ : ‘The physician treats their disease in a scientific
way and takes the patient and his family into confidence,...’
Are physicians attitudes & behavior always ideal
(2) Plato contrasted this professional wisdom attitude with the medicine for ‘slaves’ ‘The physician never listens from the slave any
account of his complaints, nor asks for any; he gives some empiric treatment with an air of knowledge in the brusque fashion of a dictator, and then is off in haste to the next ailing slave.”
1st historical description for a conflict of interest between patient and physician
Recent demystification of the medical profession
Two great upheavals : Medicine changed from an autonomous,
publicly respected profession to one vilified in the public as in the media. Doctors had fallen from the pedestal of public adulation.
Health managers appeared to be potent rivals for the authority that physicians thought they owned.
Today situationWe observed 4 paradoxes (Le Fanu, 1999)
Disillusioned doctors, seems more dissatisfied than in the past
Patient express health anxiety and dissatisfaction despite population health
Popularity of ‘alternative medicine’ contrast with the amazing success of modern medicine
Spiraling costs of health care need political control over medical decision making
This situation must induce profound changes and reforms in modern medical education.
Are medical schools able to adapt curricula to prepare physicians to correctly serve the population ?
Should students work as physicians several years after studying medicine ?
Sir James Paget (1814-1899) St Bartholomew’s Hospital Reports, 5:238-242, 1869
An old question : Is excellence of medical education sufficient to prepare professionals ?
Destiny of medical students (n=1000)
Active physician60%
Inactive28%
Died13%
Among inactive physicians 1869 J Paget 6 failed because of scandalous misconduct 10 failed due to continued intemperance and
dissipation 10 failed through bad luck 13 left or were expelled in disgrace 3 were wisely removed by friends 3 became actors 2 retired because too rich
Professionalism during medical education Professionalism must be reached by
attitude and behaviors that serve to maintain patient interest above physician self-interest
Evaluation of professional attitudes and behaviors forms a central but incompletely defined component of assessment across the medical education continuum
Analysis of formal medical training program topics
Emphasised Underemphasisedo Science o Arto Expertise o Professionalismo Bioscience o Humanismo Objective o Subjectiveo Detachment o Empathyo Evidence-Based o Relationship-centeredo Specialism o Generalismo Hierarchy o Collegialityo Intra-professionalism o Inter-professionalism
New meta-skills curricula must foster the acquisition of professionalism
Medical education is a continuum From naïve and idealist student
Undergraduate learning To experienced mature physician
Postgraduate training
Life Long Learning Continuing professional development
NEW MEDICAL STUDENT
MATURE
PROFESSIONAL
PROTO-PROFESSIONALISM
NAIVE PHRONESIS or SAGACITY
Y1 Y2 Y3 Y4 Y5 Q Reg PGT
PBL
SDLEXPERIENCE
MATURITY
+ ROLE MODELS
Hilton and Slotnick
Ideal learning and training program
NEW MEDICAL STUDENT
MATURE PROFESSIONA
L
PROTO-PROFESSIONALISM
CYNICALIDEALISTIC
Y1 Y2 Y3 Y4 Y5 Q Reg PGT
BAD EXPERIENCE
S
ADDICTIVE BEHAVIOURS
- ROLE MODELS
POLITICS
FATIGUE
Hilton and Slotnick
Hiden program
Principles for the training to professionalism
Should begin early Conducted frequently Include many different assessors Develop training for assessors Implemented long-term Use multiple methods in different
settings Provide learners with opportunities to
change
Declaration of professionalism among medical student
As a medical student, I recognize that I am now a member of the medical community. As such, I accept responsibility for my
conduct, and expect the same of my colleagues. I will display these qualities in all academic and clinical settings. I do this as an essential part of my commitment to the provision of the highest standard of patient care, which is the central goal to which I am dedicated. I will demand these standards of myself
and strive to support others to uphold them.
Signed
Conclusion
Problems linked to professionalism are not new…
Medical schools must adapt curricula and provide lifelong learning to better prepare and help new physicians to answer society needs
Trust between physicians and patients must always prevail
