Assessing Professionalism
Professional Standards
GMC
• Duties of a Doctor.
• Good Medical Practice (2006, new
edition 2012).
•Tomorrow’s Doctors (2009)
‘Medical professionalism signifies a set of
values, behaviours, and relationships that
underpins the trust the public has in doctors’
RCP, Doctors in Society, 2005
Why assess professionalism?
• Disciplinary action from medical board was strongly
associated with prior unprofessional behaviour in medical
school
•The types of unprofessional behaviour most strongly linked
with disciplinary behaviour were severe irresponsibility and
severely diminished capacity for self improvement
Papdakis et al 2004&2005
•Requirement for students to demonstrate the development of
professionalism in courses regulated by the GMC
Why assess professionalism?
• Most complaints against doctors are because of conduct not
competence
• Present behaviour can predict future actions
• Students do not arrive at medical school with a full complement of
professional behaviours –needing only teaching of medical knowledge
and skills
• Professionalism does not osmose
• All doctors are vulnerable to lapses in professional behaviour and can
benefit from explicit systematic attention in this domain
• Evidence that there may be a deterioration in professional attitudes
from idealism to cynicism
Measuring Professionalism
Arnold 2002 Academic medicine.
• Array of assessment tools, but their measurement properties need to
be strengthened
• Future research aimed at exploring rigorous qualitative techniques,
refine quantitative techniques eg OSCE and evaluate separate elements
of professionalism
• Should measurement tools be tailored to the stage of medical career
and examine how the environment can support or sabotage the
assessment of professional behaviour are central issues
Measuring professionalism
Ottawa conference 2010 recommendations
• Individual characteristics; looking at attributes, capacities and
behaviours eg psychometric tests, observable behaviour tests such as
PAT (peer assessment tool), critical incident reports, MSF(multi
source feedback). 88 tools in the literature
• Interpersonal process;interactions with other individuals and within
different contexts, collective professional values
• Macro – social level; social responsibility and morality
Interactions of these levels as a continuum, feedback required, and needs
diversity of approach.
Group work
• What system do you have for assessing
professionalism?
• What tools do you use to assess your outcomes?
Aberdeen Experience
• Student Ethical Code
• Year 1PPD.
Series of 4 lectures, 2 tutorials and 1 seminar.
Submit a single activity each term for their PPD
portfolio, assessed formatively by a tutor and possibly
the course coordinator and external examiner.
Class certificate not issued if they fail to submit by
stated deadline, absent from 10% or 2 sessions or more without
good cause.
All portfolio activities to be submitted to ‘Turnitin’ before
uploading for tutor
Aberdeen Experience
•Year 2 PPD.
Series of 2 seminars and 1 lecture.
Submit a single activity each term for their portfolio.
Same conditions apply as in Year 1.
•Year 3 PPD
One seminar on ‘Professionalism:challenges for students’
One lecture on ‘Careers’
Submit a single activity each term for their portfolio
Same conditions apply as in Year 1.
Aberdeen Experience
GP Block Year 4 and 5
Maintaining Trust
Evidence of maturity,
professionalism and
probity in general
behaviour and actions
Consider attendance,
honesty, dress and
manners.
Refer to Dress Code
found in Handbook
Always seen as acting
appropriately with
regards punctuality,
honesty, dress and
general professional
behaviour towards
patients and staff
Outstanding
Present as honest amd
have good general
professional behaviour
towards patients and
staff but not exemplary
eg with regards
punctuality, dress and
manner
Good
Dishonesty or
rude/inappropriate
manner towards patients
and/or staff.
Unacceptable
professional manner.
Fail
Aberdeen Experience
Professional Practice Block Year 5
•Four week programme, split with two weeks start of year and two
weeks end of year
•May be assessed in final OSCEs
•Students are expected to attend all sessions, failure may result in
withdrawal of class certificate
•10 key themes. Patient safety;non technical skills. Handover and
communicating with colleagues.Written communication.Prescribing
skills. How to manage stress. Medical careers:foundation
applications.Domestic abuse. End of life. Radiation protection. Clincal
ethic and law.
Group work
• Reviewing the tools for assessing
professionalism
Remediation
Attitudes v Behaviours
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Is it possible?
Relationship between attitude and behaviour is complex
Behaviour is influenced by attitude
Measures of general attitude do not necessarily predict
specific behaviours BUT
• They do have a good correlation to behaviour over a period
of time in a range of situations and contexts ( called
aggregation principle)
Conclusion
• Changing behaviour probably means
changing underlying fundamental beliefs
• Understanding ways of changing
professional attitude behaviour is for the
future
Thanks
Dr Kathy Boursicot and Dr Trudie Roberts. St
George’s Advanced Assessment Course
General Medical Council (2006) Good Medical
Practice GMC:London
Royal College of Physicians(2005) Doctors in
Society:medical professionalism in a changing
world RCP: London
Johnston J, Cupples M, Mcglade K,and Steele
K(20110 Medical students’attitudes to
professionalism:an opportunity for the GP tutor?.
Education in Primary Care 22:321-7