A hidden curriculum?
Possible to teach?
In the literature, a physician:
 Subordinates her/her own interest to those of others
 Adheres to high ethical and moral standards
 Responds to societal needs
 Demonstrates humanistic values of honesty, integrity,
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caring, compassion, altruism, empathy, respect for others
and trustworthiness
Exercises accountability of self and colleagues
Demonstrates continued commitment to excellence and
scholarship
Deals with high levels of complexity and uncertainty
Reflects on his/her actions and decisions.
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Swick HM, Towards a normative definition of professionalism. Acad Med. 2000;75:612-616
Professionalism
An expanded
definition for
physicians includes
the ability to
cultivate a
relationship with
patients, to listen to
them, and to commit
to their needs as well
as to the profession.
Harris GD, Fam Med 2004;36(5):31
314-15
Learning to be a professional is part of learning to be a
physician. Teaching professionalism is part of a
“hidden” but critical curriculum.
Definition: What do residents
think defines a professional?
Honesty and integrity
Respectfulness for others
Self improvement
Communication
Insight
Collaboration
Responsibility
Responsive to feedback
Reliability and responsibility
Compassion and empathy
Self awareness, know limits
Altruism and advocacy
Respect
Accountability
Interest in others
Timeliness
- a survey of St. Paul’s Site residents by Dr. Eva Knell
Role modelling is very important,
especially after correcting a lack of
professionalism by a learner.
Role
Modelling
“We learn by
practice and
the best
practice is to
follow a model
of the virtuous
person.”
Aristotle
1. CMA Code of Ethics,
http://www.cma.ca/index.cfm/ci_id/43892/la_id/1.
htm. This short document is also adopted by the
BC Medical Association and the BC College of
Physicians and Surgeons.
Teaching Professionalism
 Three steps to teaching professionalism include:
 1/ Serve as a proficient role model
 2/ Create a positive working environment with an
efficient, pleasant office staff
 3/ Raise the expectations of the learner so he/she
modifies behaviour, corrects self-defeating thoughts and
attitudes, and pursues excellence in all their learned or
accomplished skills.
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Harris GD, Fam Med 2004;36(6):390-2
How to teach professionalism:
 1. Role Model, role model, role model
 2. The “one minute preceptor”
 3. Discussion groups such as chart
rounds
 4. Journaling and other self reflective
practices.
 5. In clinical situations: use the
opportunity
Putting the patient first
Confidentiality
 Discussing cases in a normal part of medical
practice and learning but when is it
inappropriate?
A few more topics to consider
 Draping, patient privacy, sexual
misconduct
 Consent
 Integrity, honesty, commitment,
behavior in public
 Communication with team members,
patients and colleagues
 Right to refuse treatment
 Right of resident to refuse to
participate.
And more…………
 Other Boundary Issues: not loaning or borrowing money,
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not hiring patients
Professional responsibilities e.g. Follow up of patient
results, need to keep up to date, follow through and
continuity of care, insurance reports, conflict of interest,
attendance and being on time
Record keeping
Respect of other health professionals
Respectful language
Respecting others time by being punctual and organized
Racism, sexism, ageism, etc
CONSEQUENCES of unprofessional behavior, how
practices are monitored
Fallibility : Errors happen
 How to deal with them
 Reporting if needed and when to
report
 Self forgiveness
 Moving on
 Helping each other
Where can help be found?
 Physician Health Committee (BCMA)
 Colleagues
 CMPA
 College of Physicians and Surgeons
 Doctors who treat doctors
 Family, friends, outside interests, faith
Consequences
 Hold the residents feet to the fire!!!
Unprofessional behavior must be
corrected.
 There are consequences!
 If behavior does not change or if you do
not feel comfortable, bring it to the
attention of the Site Faculty and Site
Director
Evaluation
 Evaluation forms ask for your assessment of
professionalism and ethical behavior
 Give feedback EARLY and evaluate this area
as rigorously as knowledge and skills.
 Residents will be your colleagues some day.
Don’t wait until they have graduated from
our program to discover they have
professional issues that need improvement.
Would I like this person to treat me or my family?
Will they uphold the integrity of the profession?
Will my CMPA fees go up if this person graduates?
So, in clinical situations:
 Always consider professional issues
 Recognize and compliment
professional behavior
 Recognize and correct unprofessional
behavior
 AND role model, role model, role
model
Thank You
 This module was written as an aid to the Preceptors in
the Postgraduate Family Practice Program at the
University of BC.
 Study credit is available to groups of preceptors who
complete the module
 Please give us your feedback on the module so that we
may improve it for others.

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Email you comments to Dr. Fraser Norrie, Faculty
Development, UBC Family Practice
Fraser.Norrie@vch.ca