Meeting Minutes
Tues. 12/12/00

Discussion:

1. Minutes from last meeting approved.
    
2. Each subcommittee reported on its progress:
   
   Statement on Professionalism Subcommittee: Reported progress on the letter, which would form an abstract to the statement on professionalism and would directly invite the LUMC community into this dialogue. A copy of the draft of letter was circulated via e-mail (see below).
    
   Student Statement on Professionalism: Progress being made on text of statement. Progress would pick up now that they had a draft of the letter from the Statement on Professionalism Subcommittee.
    
   Integrated Curriculum in Professionalism: This committee had presented detailed recommendations at the previous meeting. It was generally agreed that this subcommittee had probably completed its work. It was noted that several of the subcommittees were converging on the need for faculty development related to professionalism Thus, a beefed up section on recommendations for faculty development was suggested (see below) to be incorporated into the previous week’s recommendations.
    
   Student Maltreatment: The survey was distributed to students and returns were beginning. The entire committee took up the issue of recommendations regarding a reporting mechanism for incidents of maltreatment. It was agreed that the incidents of perceived maltreatment were clearly under-reported. So, it is important to create a mechanism that will make it more comfortable for students to raise concerns of maltreatment but which would also provide significant feedback and discussion prior to the initiation of any formal action. The group concurred that a multi-tiered system is in order. For instance, the student would approach:
   

(1)    An Advocate – this person would be a class officer, a designated faculty member, or an administrator who has a reputation as someone who is sensitive to student concerns. This person would provide a sympathetic ear to the student’s concern and explore the student’s options. The committee anticipates that the student and advocate would usually choose to proceed no further with most complaints.

(2)   A Three Member Panel – If the advocate wished a second opinion, s/he could consult a panel that is designed to hear complaints. They could first be consulted informally to determine if further action is worth pursuing. If they agree that it is, the panel could convene formal hearing. The panel would send its findings and recommendations to the Dean. 

1. The panel should be broadly representative of the faculty, administration, and student body.
2. The advocacy system allows that the approach to the panel could be made while the student remained anonymous. Only when a formal proceeding was begun need the identity of the student be known.
3. The advocacy system provides the student with support regardless of the level at which the student’s concerns are ultimately addressed.

Appendices

A. Draft of letter on professionalism to the LUMC Community

Dear Colleague:

We write to ask your support and participation in fostering a more professionally supportive environment at Stritch School of Medicine.  Recognizing the professionalism and professional development is larger than curriculum alone, Myles Sheehan, Senior Associate Dean, appointed an ad hoc committee of faculty, students, and administrators, and charged us with examining how we might improve the curriculum and facilitate professional behavior among our students. Our discussions on each of these areas have lead to the inescapable conclusion that engaging the larger LUMC community is critical to achieving 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 faculty, both medical and basic science, resident physicians, other health-care professionals, and administrators.

The purpose of this letter is to share our recommendations and suggestions for implementation and to expand the dialogue concerning professionalism on our campus. We believe that fostering professionalism is a responsibility that all concerned with justice will welcome. The current health-care climate exerts a variety of financial pressures on physicians and the institutions that train them that can dehumanize the art of medicine. Today’s physicians and health-care institutions face the challenges of: treating more patients in less time; curtailments in or denial of reimbursement for care; and offers of bonuses, grants, and gifts that can cloud judgment as to what is truly in the patient’s best interests. Professionalism is the state of character that habitually asserts the primacy of the patient’s interests in the face of such obstacles and remains proactive in contributing to the common good.

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.  Our philosophy counsels rewarding effort and excellence and provision of formative, not punitive, feedback.  We have found much to celebrate at Loyola in all of the areas we have studied, suggesting that a commitment to professionalism already exists that could be enhanced by intentional discussions, themes, expectations, development, and reflection as a community.  Our recommendations to Dean Sheehan include:

(1)   That a climate of self- and peer-regulation be fostered among the medical students in the pre-clinical years. Development and implementation of an appropriate student statement on professionalism may help students to see that their character is the most important outcome of the rigorous program of study of their first two years of professional training;

(2)   That the climate of professionalism be enhanced in the clinical training of the medical students. Expectations of professional behavior should be explicitly articulated by clinical mentors and evaluated by all to whom physicians are accountable including mentors, peers, nurses and professionals of all health-care disciplines, and patients and their families. Educational activities that foster this climate should be devised and incorporated into each clerkship;

(3)   That the positive role modeling behavior of residents and faculty be explicitly recognized. Similarly, effective and realistic mechanisms that allow for constructive feedback regarding the unprofessional behaviors of residents and faculty must be developed. Medical students will only take the culture and values of professional self-regulation seriously if their role models incorporate them as a routine part of their clinical teaching and practice;

(4)   That means of recognizing and reinforcing the positive leadership aspects of our students and faculty be developed. For instance, SSOM students are often distinguished by their substantial voluntary service efforts. A method of tracking and reflecting on these endeavors with mentors and other members of the professional community would likely reinforce and expand these signature programs;

(5)   That committees on professionalism be formed among the other disciplines such as nursing, social work, and health-care administration. These disciplines aim at the common end of patient care as well. They must be invited to dialogue with the faculty physicians, residents, and medical students in order to increase cooperation.

Minutes from our meetings and subcommittee reports are accessible on our website, www.lumen.luc.edu/internal/profcomm/, and a statement on professionalism is attached.

B. To be integrated into the recommendations of the Subcommittee on an Integrated Curriculum in Professionalism:

Recommendations:

1. Faculty/ Resident Development

Observing and participating with professionals at different stages in training reinforces principles of becoming a professional.  In order to succeed in promoting professional development, faculty and resident efforts that will be reciprocal and complementary to those expected of the students must be promoted. The medical students will only learn appropriate ways to set professional goals and self-monitor their progress in they observe this behavior in their mentors. In particular,

• Faculty should partake in any portfolio assessment technique that is implemented in the SSOM curriculum. Faculty will be needed to serve as advisors who oversee the development of a student’s goals at the beginning of the academic year and review their progress with them at the end. It would be highly beneficial to the students if each advisor would develop and share his or her goals related to scholarship, service, and improving interaction with colleagues and students. In the case of clinical faculty, goals should include ways to improve relations with residents, patients, families, nurses, pastoral care and other related professions. It is important that a “critical mass” of teaching faculty be enlisted into this effort in order for the ethos of professionalism to be promoted.
   
• Faculty will need to be oriented and trained to participate in the portfolio activity and other professionalism education efforts. This training should include insight into the reciprocal responsibilities of faculty to which they are invited by the student honor code. Some annual orientation and training session should be developed.
   
• Clinical faculty who participate as student advisors should also be responsible for implementation of a professionalism education session on their service for faculty and residents. This session can be structured in a variety of ways, e.g., didactic, case discussion, etc.
   
• The professional evaluation of faculty and residents by their superiors should include evaluation on the professional treatment and mentorship of students. Excellence in this area should be clearly recognized and respected. Failure to achieve excellence in this area should be occasion for constructive criticism and formative evaluation.

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