The Professionalism Committee - Meeting 12/05/2000

Meeting Minutes
Thurs. 12/05/00
The Professionalism Committee
Meeting Minutes
12/05/00

Present

Mark Kuczewski, (new member Elisa Gordon) Tammie Morris (acting recorder), Eva Bading, Pam Derstine, Greg Ozark, Charles Webber Ash Mansour & Fred Wezeman, Mary Langbein & Teresa Wronski. Students: Cynthia Brincat (M1), Ryan DeLee (M2), Andrew Makowski (M2) and Sam Johnston (M3) Absent: Mike Takacs (M4), Greg Matz, and Greg Ozark

Discussion

Minutes from last meeting approved.

Sub-committee review/task/recommendations:

Statement on Professionalism:

First draft of the letter to the LUMC community that will serve as an abstract of the longer statement was circulated. Two comments noted for revision to second draft: (1) The usual problem of tying an SSOM statement to larger issues of professionalism across the professions that make up LUMC was raised. This issue is unavoidable as the committee is an SSOM committee. However the rationale as to the interlinking of the education of the medical students with the larger community can be clarified. (2) Some language regarding reciprocal relations between faculty and students should be added.

Honor Code Subcommittee:

Honor code statement to be integrated into white coat ceremony
Student buy-in - The modified code of conduct will be presented to the student body by the deans at an open forum with discussion to follow. We will post the code in the communities as a resolution to be adopted/passed. Students can review it and ask questions of the committee via E-mail or meet in person at designated times. At the end of the discussion period the code will appear as a main item of business at an MSU meeting. All students will be invited to a public debate (the former being private) and the student reps can vote. Alternative--a vote of the student body with a predetermined percentage required to pass.
This will be a Stritch focus of the statement on professionalism and will flow from it. Therefore, it will make direct reference to it as much as possible and will be used to "clarify" certain points and relate them to pre-clinical and pre-M.D. life. - Add language of “shared responsibility & reciprocity” to statement.
Wording will need to wait until the statement of professionalism draws closer to completion so that we can reference it and follow it as closely as possible.
(note--we now have a draft from which we may proceed)
Points to be covered: testing procedures, relation of student to faculty/mentor, the SHARED responsibility of students and faculty (i.e. faculty must specify authorized aid and resources for that class in the syllabus; students must respect and adhere to their definition).
Possibly integration into white coat ceremony
Needed info--faculty buy-in. Faculty Senate? How?

Integrated Curriculum Subcommittee:

See **attached recs**
IPM III focus (?)
Portfolios – important to set objectives and assess process of meeting objectives. Perhaps an exercise each student can do with advisor. Will need a training session for advisors and teach advisors to set their own goals and share with students.
Professionalism sessions integrated into case conferences – modeled on Family medicine’s biopsychosocial project. Must supply outline to students of what they bring to conference in way of information

Student Maltreatment - Revising the current policy
<http://www.meddean.luc.edu/ssom/depts/admin/camplife/handbook/pol13.htm>

Reporting misconduct of residents not obviously included in the current policy.
Policy is designed a bit too much with lakeshore in mind, that is, the director of campus life is unlikely to be utilized at SSOM as a reporting mechanism for student misconduct.
Courses are sometimes multidisciplinary, thus departmental chair to report an incident to is ambiguous.
Departmental chairs are too daunting as point of first contact. Ombudsman position was eliminated, a new single point of contact needed & anonymity assured.
Student complaint could potentially be reviewed by a committee of one chairman, med student, SW, and an Associate Dean of Student Affairs. (Question worth considering: if the issue takes place in a clinical setting, is it helpful to include other professions as part of review committee, e.g., pastoral care, faculty, nurse?)

Comments received on e-mail regarding reporting mechanism:

Greg Matz:	Committee chair one med student, Father O’Callaghan, Terry Wronski one clinical faculty and one basic sci faculty.
Andy Makowski:	Perhaps there should be 2 or 3 initial contacts (re: maltreatment). This would give students some options and allow them to go to whom they feel most comfortable. More importantly, it protects a student from being forced to go to a member of the administration if the student feels mistreated by the administration. These 2-3 contacts should represent different entities within LUMC to ensure that a neutral 3rd party can indeed be found.
Charles Webber:	I agree that some official committee must be instituted that would service student complaints of abuse in a medical center context. As we all agree, reporting students must have feelings of safety and freedom from fear of reprisals. But approaching an entire board, as neutral as it might be, could still be an intimidating experience in these type of cases. Would it not be wise to have certain individuals, student advocates, who could serve as liaisons between students and board? One-on-one bespeaks a much more friendly atmosphere. We obviously need significant and continuing discussion on this important issue.

**attached recs below**

Professionalism Education Sub-committee Recommendations

Background

The purview of the Education sub-committee is to make recommendations regarding the development, implementation, and evaluation of an integrated curriculum on professionalism. The initial step in the process was to catalog topics currently in the undergraduate medical education curriculum as well as identify the organized clubs/activities, volunteer projects, and service commitments that students participate in across the four years of medical school. A review of the curriculum, both formal and informal, provided the basis for the following observations:

There is distinctiveness yet overlap in topics spanning end-of-life, ethics, professionalism and spirituality.
Stritch curriculum (formal and informal) is rich in content and experiences fostering professional development of students; a hallmark of the medical school.
There needs to be a clear set of measurable objectives to guide curricular development in professionalism. Currently, decisions regarding professionalism content and experiences are made by course directors rather than having institutional goals and objectives guide curricular development. Additionally, there must be better methods to assess the outcomes of the curriculum.
The curriculum targets medical students only; the scope should be broadened to involve residents and faculty.
A challenge is applying content to practice.

Recommendations

Curricular Objectives
Recommendation: Develop objectives to guide professionalism curriculum development. Review LEEP objectives and re-write in measurable terms the global objectives related to professional development in the Ideal Graduate report.
Topics on Conflict of Interest
Recommendation: Add topics regarding conflict of interest in the curriculum, including areas such as, taking gifts from drug companies, taking money to recruit patients to clinical trials, and having stock options in companies supporting research. Currently, IPM I has a small group discussion case on pharmaceutical company relationships. Recommend topics be expanded in IPM curriculum (I, II, III) and there may be an opportunity to build these topics into some standardized patient teaching and evaluation scenarios used throughout the curriculum.
Topics and experiences in Cultural diversity
A curriculum proposal has been developed by the Design sub-committee of the CCA, (attached). The proposal will be acted upon by the CCA.
Clinical education
Recommendation: Identify professionalism/ethical issues/topics currently being discussed or presented in clerkships that may not be reflected in the course objectives. Clerkships provide the laboratory for applying education to practice. There are opportunities to observe and act to assist in patient care dilemmas (e.g. conflict resolution, communicating bad new, demonstrating respect for diversity).
Provide ethics/professionalism cases as part of the core curriculum in each clerkship. Facilitate more opportunities for discussion of health care issues that may create conflict of interest for the physician (e.g. payer issues, patient autonomy). The biopsychosocial project in Family Medicine is an excellent method to explore the dynamics of illness on the patient and could be adapted for other clerkships. The student performance evaluation needs to be revised to assess professional development.
Introduction to the Practice of Medicine III
Recommendation: Expand IPM III to provide more opportunity for presentation and discussion of third year core curriculum topics, including professionalism. Increase the number of sessions from 5 to 10 (monthly sessions). IPM III is a third year course using a conference format to present a series of topics that expand on the IPM I and II curricula with particular focus on clinical applications. A variety of presentation methods are used, including lectures, panel discussions, and small group sessions. Small groups are organized by clerkship (Medicine, Peds, etc.) providing opportunity to discuss patient cases and apply concepts to patient care. Students learn very early the work ethic of medicine, but are not encouraged to problem solve the vast array of issues in patient care. Team building and communication skill development are additional benefits of group interaction. Discussion groups should include students, residents and faculty.
Resident/Faculty Development
Recommendation: Provide opportunities that integrate education for all learners; students, residents and faculty. Observing and participating with professionals at different stages in training reinforces principles of becoming a professional. In order to succeed in promoting professional development, resident education must be a focus of the plan.

Implementation

The recommendations will be forwarded to the CCA for discussion and action. It is important to survey existing course/elective directors to determine if professional development is an objective of courses.

Evaluation

Suggestions for assessing outcomes:

Portfolio - a collection of material made by students that records and reflects key events, learning experiences and processes in their professional development. A record of service activities, critical incidents in patient care, ethics paper, standardized patient videotapes, etc. are included. Portfolio is reviewed by "mentor/advisor" periodically, and students may present information from their portfolio at certain times over the four years.
360� evaluation - performance feedback from all members of a patient care team. The limitation of this tool is timeliness of feedback and administration of the system.
Intern survey - Solicit feedback from interns at the end of the year as a measure of their preparation and patient care knowledge/skills/attitudes.
Graduation Questionnaire - Association of American Medical College survey of medical school graduates has items on professionalism.
IPM III - conduct a recap of activities/sessions at the end of the year to assess achievement of course objectives and discuss student development of clinical competence in the third year.
Clerkship student performance evaluation - strengthen the assessment of professional development in the clerkships. This could include improving the evaluation form and incorporating items on an end-of-third-year competency exam. Self-assessment is also an important component of the evaluation process.

Meeting adjourned approximately 1:00 p.m.

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