|
|
Statement on Professionalism in Medical
Education
An Invitation from the SSOM Ad Hoc Committee on Professionalism to the LUMC
Community
We invite all members of the Loyola University Medical Center to join in dialogue with us to promote a vision of Loyola as a unique environment that supports professional growth and behavior, with expectations that are shared and celebrated among all of us, including medical and basic science faculty, resident physicians, other health-care professionals, and administrators. We have systematically reflected on what it means to be a professional and what objectives we must undertake in order enhance Loyola's capacity to foster professionalism. We believe that our conclusions are sound but can clearly be enhanced through dialogue with all facets of the LUMC community.
What is Professionalism?
A profession is a calling that requires specialized knowledge and a commitment to quality work. Acquiring the necessary skills usually requires a period of arduous training. It is distinguished from other means to a livelihood by its embrace of a set of values and by having a service rather than a proprietary orientation. Because of the desirable ends a profession can accomplish and its commitment to service, professions are often given considerable autonomy by society.[1]
Professionalism is the conduct, aims, values, or qualities that characterize or mark a profession or a professional person. Professionalism in medicine is the principles and qualities that are identified with a good physician, the values that make medicine honored and honorable. Medicine requires that persons who are often vulnerable due to illness or other circumstances must be able to trust that the physician will give primacy to their interests as patients. Professionalism is the set of qualities in virtue of which a physician is worthy of this trust and that convey that trustworthiness to others.
These qualities typically include:
Professionalism within the Loyola University Medical Center community is characterized by a dedication to serve those most in need and recognition of the importance of mercy and forgiveness within a framework of mutual respect, education, growth, and measured corrective response.[2]
How is Professionalism Developed?
The set of qualities that make up professionalism in physicians are not restricted to the actual physician-patient encounter but are developed through training and habituation in related tasks such as research, study, and encounters with superiors and peers. Therefore, it is important to develop the kind of habits that will come to be called "professional" during pre-professional training. And, as good habits can become lax, it is important for even the accomplished professional to periodically review his or her professional comportment and to receive the constructive criticism of others.
Professionalism is not something that is learned or furthered in isolation, but requires being a part of a community that fosters the values and behaviors associated with the profession. Each community has a "culture" of professionalism. This culture encompasses a wide variety of relationships that contribute to the mission of the community. The Loyola University Medical Center has patient care, educational, and research missions. All efforts are ultimately directed to patient care as the goal of medicine. Of course, medical education and research are important means by which patient care is promoted and perpetuated. The practice of medicine, medical education, and research require the contributions of a wide variety of professions in addition to the medical profession, e.g., basic scientists, nurses, social workers, pastors, and administrators. Each shares in the tripartite mission of the LUMC community and participation in that community requires professional behavior that contributes to one or more of these missions. Each member of the community contributes to or detracts from the professional culture but the culture always remains more than the sum of its parts.
How is Professionalism Judged?
The culture of a professional community is one in which the standards are defined by the profession in negotiation with society.[3] The profession is the judge of any individual's attainment of those ends. This is the process of peer-review. This process requires certain virtues on the part of those undergoing review as well as those reviewing. Every member of the profession must instantiate both sets of values as reviewing and being reviewed are life-long processes. This process requires trustworthiness, honesty, humility, and self-effacement. These are necessary in order to learn from one's mistakes. The process also requires that those reviewing never lose sight of the goal of helping the other to learn from the experience, not to punish them or to gratuitously take advantage of the vulnerability of the learner. Once again, this process must be conducted in this manner because it is meant to contribute to patient care. All education at LUMC must always take as its standard its contribution to patient care.
Does Being a Jesuit and Catholic Institution Have Any Import for Considerations of Professionalism at Loyola?
The profession of medicine, in general, requires an ability to put the interest of another, the patient, ahead of one's self-interest. Similarly, all of the professions that develop and train physicians must have a similar ability to direct themselves toward goals beyond themselves. For instance, faculty in every educational area must be dedicated to the search for truth and its transmission. The maintenance of these professions, through service to academic and professional societies also requires a willingness to go beyond one's immediate self-interest. Other interests must be subordinated to the ends. Although the professions can thrive with many members who are lax in their commitment to professional ideals, the Jesuit, Catholic heritage of SSOM asks more from each and every member.
The Jesuit, Catholic tradition is one of service, a call that is interpreted as "living for others." This ideal asks each member of the community to see his or her profession as a vocation characterized by the promotion of justice.[4] Professionalism in the context of the Jesuit, Catholic tradition, therefore, calls for the highest standards of conduct toward patients, students, colleagues, and all members of the Loyola community. It also asks for the development of a social conscience that is ever regarding of the viewpoint of the poor and disenfranchised.
Of course, the Judeo-Christian tradition is a faith tradition that also emphasizes mercy and forgiveness. Thus, failure to achieve the ideals of the institution and mistakes should be met with corrective responses that enhance the formation of the person. Punishment has no intrinsic value within this frame of reference and is not pursued for its own sake.
How Can a Climate of Professionalism be Fostered at SSOM and LUMC?
A climate of professionalism requires that each profession participate in a genuine community of the many professions represented at LUMC. The professions must demonstrate mutual respect and this entails formative feedback among them. For example, facilitating professional behavior of medical students toward nurses requires that nurses can provide constructive criticism to medical students and that medical school faculty model such interactions. Feedback mechanisms and interactive educational sessions need to be developed that bring together various professions and their students.
We found that there are many areas in which the LUMC community excels. Our faculty is dedicated and our students are admirable. This is evidenced in the large number of ongoing service projects that the students sustain and the many students who actively pursue an interest in biomedical ethics and professionalism. It is our belief that the environment of our campus will be enhanced simply by making these strengths a subject of creative reflection among faculty and students. In particular, we recommend that exercises that require students and faculty to set goals related to each major area of professionalism and periodically review progress toward these should be required. This "professionalism portfolio" would create an opportunity to accentuate the strengths of our students and to recognize outstanding achievement in these areas. Mistakes and transgressions are encouraged to be included for review and seen as a learning opportunity. Such exercises can also mirror the "forgive and remember" learning environment that is so necessary in professional education.[5]
A climate in which students, faculty, and all health-care professionals are self-critical and open to the formative feedback of others is the ideal toward which we strive. However, we must be realistic enough to know that missteps will happen and we must have user-friendly mechanisms for dealing with the occasional situation of egregious behavior. Our recommendations suggest that such mechanisms be multi-tiered to protect the interests of all parties involved. Students have an interest in being able to discuss perceived problems. So, one tier must be a place where students feel comfortable discussing their perceptions and using the opportunity to develop strategies for dealing with such situations. But, should such discussion result in the conclusion that serious maltreatment has occurred, the student must be able to procure the advocacy of a mentor who can guide them through the ordeal of pursuing the matter administratively.
Ultimately, no one strategy will foster an improved professional climate. However, a concern for professionalism is the sine qua non of progress. By bringing together concerned professionals in a variety of forums and committees, we believe that new and more creative ways to address these issues will be found. It is to this task that we invite you. We will seek to provide forums that can foster this exchange, and to provide information on how our efforts relate to a burgeoning attention being given to professionalism by accreditation councils and medical boards. We hope you will utilize these and seek to create additional mechanisms. You may also contact Mark Kuczewski, PhD, mkuczew@lumc.edu with comments about our work or suggestions on how to foster this dialogue.
[1] WA Hensel and NW Dickey, (1998) Teaching Professionalism: Passing the Torch, Academic Medicine, 73 (8): 865-870.
[2] M. Sheehan, memo to Mark Kuczewski, August 25, 2000.
[3] MK Wynia, et al., (1999) Medical Professionalism in Society, New England Journal of Medicine, 341 (21): 1612-1616.
[4] PH Kolvenbach, (2001) True Solidarity: The Service of Faith and the Promotion of Justice in American Jesuit Higher Education, America, 184 (3): 8-12.
[5] CL Bosk, (1979) Forgive and Remember: Managing Medical Failure, Chicago: University of Chicago Press.
Return to Professionalism Committee Home Page
©2001 Loyola University Stritch School of
Medicine (SSOM). All rights reserved.
This document is intended for viewing by authorized personnel within SSOM only.