Being a role model for students in
your practice
Jaime Correia de Sousa, MD, MPH
Horizonte Family Health Unit
Matosinhos Health Centre
Porto, Portugal
Kranjska Gora, Slovenia, September 2004
“We learn by practice and the best practice is to follow
a model of the virtuous person.”
Aristotle
(384-322 B.C.)
Aristotle was born in Stagira in north Greece, the son of
Nichomachus, the court physician to the Macedonian royal
family. He was trained first in medicine, and then in 367 he
was sent to Athens to study philosophy with Plato.
He stayed at Plato's Academy until about 347. Though a
brilliant pupil, Aristotle opposed some of Plato's teachings,
and when Plato died, Aristotle was not appointed head of
the Academy.
After leaving Athens, Aristotle spent some time travelling,
and possibly studying biology, in Asia Minor (now Turkey)
and its islands. He returned to Macedonia in 338 to tutor
Alexander the Great; after Alexander conquered Athens, Aristotle returned to
Athens and set up a school of his own, known as the Lyceum.
After Alexander's death, Athens rebelled against Macedonian rule, and Aristotle's
political situation became precarious. To avoid being put to death, he fled to the
island of Euboea, where he died soon after.
Summary
• Medical professionalism
• Role Modelling as a Multidimensional
Concept
• Advice to young doctors
• The family physician as a role model
Three core elements of medical professionalism
 A dedication to serve and care for patients, including placing individual and
public health needs over one’s own interests
 An open expression of principles with accompanying commitments, such as
never taking advantage of patients or abandoning them
 A willingness to work with others to include patient and societal needs in the
practice of medicine while simultaneously protecting essential health care
values.
Clinical Knowledge as a journey Novice to Expert
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Novice
Advanced beginner
Competent
Proficient
Expert
Instructor Role
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Organisation and clarity
Group instruction skills
Enthusiasm
Knowledge
Clinical supervision
Clinical competence
Modelling professional characteristics
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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Role Modelling as a Multidimensional Concept
 Ethics – broad curricular effort to develop physicians’ values, social
perspectives, and interpersonal skills for the practice of medicine; the goals
of Ethics education include sensitising, consciousness-raising, and
uncovering hidden problems and value issues
Medical ethics education has failed to adequately recognize the centrality of
role models in the moral and ethical formation of new physicians. Medical ethics
as a subject in applied ethics with a clear set of curricular goals, and medical
ethics as the moral commitments and character development of health care
professionals are distinct topics.
The goals of Ethics education include sensitising, consciousness-raising, and
uncovering hidden problems and value issues. Reclaiming these goals may
help us to cut through layers of enculturation, habit, and verbal debris to
rediscover, with clarity, the moral purpose of medicine.
Virtuous physicians both model good behaviour and comprehend the reasons
for their choices; virtuous physicians can explain why they are acting in a given
manner, and are motivated by concern for the whole patient.
 Apprenticeship – a touchstone of professional education; apprentices learn
through participation in an environment, where “ways of being” are modelled.
 Situated learning – the learning that occurs in the context of practice,
including knowledge, skills and social norms; professionals learn from
participating in, and gradually being absorbed into, communities of practice
 Observational Learning – ability to learn from others in their environment
through social and cognitive practices, a powerful means of transmitting
values, attitudes, and patterns of behaviour; it occurs when we watch others’
actions and the consequences of those actions.
A key concept of situated learning is legitimate peripheral participation.
Learners enter the community of practice at the periphery, where they are
novice legitimate participants. As they move towards fuller participation, they
participate as a way of learning and both absorb and are absorbed into the
culture of practice. Accordingly, learning becomes an integral and inseparable
aspect of social practice. It provides exemplars, such as masters (or role
models), finished products, and more advanced apprentices, and these are the
basis and motivation for the learners’ activity.
Observational learning People learn from others in their environment through
social and cognitive practices. Observational learning is well accepted as a
powerful means of transmitting values, attitudes, and patterns of behaviour; it
occurs when we watch others’ actions and the consequences of those actions.
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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 Reflective Practice – integrates or links thought and action with reflection. It
involves thinking about and critically analysing one’s actions with the goal of
improving one’s professional practice
It also provides faculty, students, and practicing professionals a means to learn
effectively from experience and develop the affective aspect of their
professional expertise by considering experience critically and understanding
how knowledge, attitudes, and skills develop
Advice to young doctors
 Learn to cope with uncertainty
 Challenge what you are taught, especially if it seems inconsistent or
incoherent
 Regard your knowledge with humility
 Be yourself at all times
 Enjoy yourself
 Try to practise medicine with the same ethics and principles you believed in
when you started medical school
 Never be afraid to admit your ignorance
 Medicine is not only clinical work but is also concerned with relationships,
team work, systems, communication skills, research, publishing, and critical
appraisal
 Treat your patients with the same care and respect as if they were your loved
friends or family
 Cure is not what everyone is expecting from you: your patients and their
families may be just seeking support, a friendly hand, a caring soul
 Outside the family there are no closer ties than between doctors and patients
 Don’t believe what you read in medical journals and newspapers
 Aim at knowing how to learn, how to get useful medical information, and how
to critically assess information
 The first 10 times you do anything—present a patient, put in an intravenous
catheter, sew up a laceration—will be difficult, so get through the first 10
times as quickly as possible
 Although you should not be afraid to say “I don’t know” when appropriate,
also do not be afraid to be wrong
 Cherish every rotation during your training, even if you do not intend to
pursue that specialty, because you are getting to do things and share
experiences that are special
 When you have a bad day because you are tired, stressed, overworked, and
under appreciated, never forget that things are much worse for the person on
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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the cold end of the stethoscope. Your day may be lousy, but you don’t have
pancreatic cancer
The family physician as a role model
To be an effective role model, the clinical teacher must demonstrate all facets of
professionalism in his/her own practice.
Actively role modelling professionalism will
enable the family physician tutor to more
effectively teach different aspects of
professionalism and better assess a learner’s
professionalism.
This emphasizes the importance of
consistency between the standards of
behaviour expected of the students and the
standards of the faculty. The faculty has a
responsibility for the attitudes and actions
that they model for their students, the education and professional growth of
learners, and the accurate assessment of each learner’s professionalism.
We should strive to present a strong, enthusiastic character, demonstrating
humility and maintaining competency in our specialty. This requires maintaining a
current knowledge base, promoting trust, and portraying a positive attitude
To be an effective role model, the clinical teacher must demonstrate all facets of
professionalism in his/her own practice. Actively role modelling professionalism will
enable the preceptor to more effectively teach different aspects of professionalism
and better assess a learner’s professionalism.
• The consistency between the standards of behaviour expected of the students
and the standards of the faculty and the family physician teacher (tutor) is very
important
• The faculty and the tutor have a responsibility for the attitudes and actions that
they model for their students, the education and professional growth of learners,
and the accurate assessment of each learner’s professionalism
For the office-based preceptor, the challenge is demonstrating humanism,
compassion, and altruism during a 15-minute office visit while dealing with daily
aggravations such as third-party payers dictating which tests are necessary, the
limitation of medication choices through restricted formularies, and other barriers to
the development of a therapeutic physician-patient relationship. Ironically, these
situations also create the opportunity and potential for the learner to remain
idealistic and altruistic.
The preceptor can reinforce the concept that becoming a physician is a privilege as
well as emphasize the role of keeping the patient first through a demonstration of
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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advocacy and patient centeredness, allowing the patient to express his/her wishes
and be involved in the decision-making process and not permit financial incentives
to affect the evaluation and management of the patient.
Being a Role Model
• Students and young doctors identify:
– enthusiasm, compassion,
– openness, integrity, and
– good relationships with patients
as attributes they seek in their role models.
• They are also drawn to senior figures who embody responsibility and status
What qualities do students and young doctors look for in role models?
The most important qualities in role models were a positive attitude to junior
colleagues, compassion for patients, and integrity.
•
Students and young doctors identify enthusiasm, compassion, openness,
integrity, and good relationships with patients as attributes they seek in their
role models.
•
They are also drawn to senior figures who embody responsibility and status
•
Some senior doctors show poor attitudes and unethical behaviour, causing
confusion, distress, and anger in young doctors and students under their
supervision.
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Role models may not be a dependable way to impart professional values,
attitudes, and behaviours
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Professional behaviour and ethics should be explicitly taught through peer
group discussion, exposure to the views of people outside medicine, and
access to trained mentors
Being a Role Model
• Role models may not be a dependable way to impart professional values,
attitudes, and behaviours
• Professional behaviour and ethics should be explicitly taught through peer group
discussion, exposure to the views of people outside medicine, and access to
trained mentors
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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A Good Role Model
• Shows an attitude of compassion, openness and integrity
• Is punctual, pleasing look, friendly
• Is well organized, gives clear instructions
• Has a balanced personality
• Looks after him/ herself
• Masters knowledge in his or her field of expertise
• Has sound clinical reasoning
• Speaks clearly, with precision and in a language understandable to
the patient
• Assures continuity of care
• Remains up-to-date and cultivates intellectual curiosity
• Establishes a confident relationship with the patient and his or her
family
• Possesses a good sense of professional responsibility
• Plans the investigation (choice of tests, cost–benefit, and risks) and
interprets the results
• Treats the patient and carries on the follow-up
• Knows and respects his or her limits
• Demonstrates good technical skills
• Conducts the interview with patience and gentleness; is sensitive to
the patient’s reactions
• Shows empathy
• Considers the patient’s point of view during the interview, particularly
during decision making
• Emphasizes a bio psychosocial approach
• Demonstrates intellectual exactness and critical judgment
• Demonstrates good control of a medical interview
• Respects the patient as a person
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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
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
Letters. What's a good doctor and how do you make one?
http://bmj.bmjjournals.com/cgi/reprint/325/7366/711
Jaime Correia de Sousa
Kranjska Gora, Slovenia, September 2004
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