The Professionalism Committee - Letter to Dean Sheehan

February 1, 2001

Myles Sheehan, SJ, MD
Senior Associate Dean
Stritch School of Medicine
Loyola University Chicago
Maywood, IL 60153

Dear Dr. Sheehan:

I am writing to provide you a summary of the conclusions that have been reached by the ad hoc committee on professionalism. You charged us with four tasks: (1) Design an integrated curriculum on professionalism, (2) Make recommendations regarding student maltreatment, (3) Design a student honor code, and (4) Create a statement that invites the larger LUMC community into a dialogue on professionalism. I am pleased to report that we have made substantive progress and have several insights to share in each area. I enclose our final report on this phase of our activity.

We have found much to celebrate at Loyola in all of the areas we studied, suggesting that a strong commitment to professionalism already exists. We believe that these strengths can be enhanced by inclusive discussions, clarification of expectations, and sustained reflection among the members of the Loyola community. Below, are the chief recommendations we endorse.

I. Integrated Professionalism Curriculum

Ongoing Portfolio Assessment - The goals of self-reflection and role modeling of professionalism can be enhanced through a professionalism portfolio assessment. Students should set personal goals related to each area of professionalism, e.g., service, appropriate interaction with mentors, peers, patients, and others, and reflect periodically upon their progress toward their goals with a mentor/advisor. Their faculty advisors should also undertake this exercise to role model its importance.

We believe that this kind of assessment serves several important functions. First, it serves to recognize the enormous efforts many of our students already in areas such as service and self-education. Second, it provides faculty reinforcement on a continuous basis. Third, it provides an opportunity to discuss mistakes as well as successes and to use both as learning experiences. Fourth, goals can be set in relation to related health care professions, e.g., nursing, and to collect evaluative information regarding cross-profession interaction. Fifth, and perhaps most important, the role modeling of the faculty advisors will require and contribute to faculty development.
Our review of the SSOM curriculum showed that the offerings related to professionalism, both those that are required and those that are voluntary, are impressive and fairly complete. Only offerings related to conflicts of interest in the health care and research are obviously in need of creation. Hence, our main recommendation, as instanced by the portfolio assessment suggestion, is to more closely integrate related elements. In addition to the portfolio assessment, the development of exercises that sharpen students' skills in talking to patients about end-of-life decision making and the running of family decision-making conferences are recommended. Such exercises can build upon the current standardized patient activities in the IPM-3 course or the medical humanities selectives.

II. Student Maltreatment

We believe that there is strong evidence that our students do not report most instances of maltreatment. Current policy directs students to report such incidents to course directors or department chairs. We believe that students need a more approachable first point of contact. Persons such as class presidents, popular faculty members, and campus ministers can provide an ear for students and help them to develop strategies for dealing with difficult situations. If such discussions reveal that the situation constitutes serious mistreatment, this point of contact can serve as the student's "advocate" and represent him or her to a three-member panel that would hear the complaint. This panel would report its findings to the Dean of the medical school.b
Each clinical department should be responsible for developing an educational program for its faculty and residents. This program would include behavioral objectives and individuals should be held accountable for achieving these objectives and outstanding achievement in these areas recognized.

III. Student Honor Code

Under the tutelage of Associate Dean Wronski, several of the student members of our committee drafted a student statement on professionalism. This is an outstanding document that suggests students should be made aware of the commitment to professionalism that is expected at Stritch and the methods for developing it. Among the recommendations they made include the self-setting of goals with an advisor and the development of peer feedback mechanisms as part of the portfolio exercise.
The student members of our committee will need to introduce their document to the classes and to build a consensus for their ideas, and possibly, to revise their recommendations in light of constructive criticism from their constituency.

IV. Statement on Professionalism

Our committee has crafted a statement on professionalism and an open letter to the LUMC community. The open letter highlights certain aspects of the statement and invites the members of the LUMC community into this dialogue. Because health-care institutions and medical schools have a climate and culture of professionalism, substantive progress will require widespread efforts, not the efforts of a few.
Our letter and statement reflect the ideal of universal participation in the enhancement of the culture of professionalism at LUMC and SSOM. We recommend the development of forums that address issues of professionalism and that bring together members of all the professions represented at LUMC, e.g., physicians, nurses, social workers, chaplains, and others. Ways to include the participation of medical students and residents should be sought. In the case of residents, this challenge is particularly challenging but especially important to us as they often serve as the main clinical educators and role models of our medical students.
Our letter and statement make clear what we believe to be the LUMC philosophy of professionalism. This philosophy derives partly from the nature of medicine in our society and partly from Loyola's Catholic and Jesuit heritage. We believe that professionalism entails responsibility for self-reflection and self-development. It entails service to others, especially those who are most in need of service. At LUMC and SSOM, we found an enormous concern and amount of activity directed to serving those in our community who are underserved and large numbers of faculty and students who routinely avail themselves of voluntary educational opportunities to improve their knowledge and skills related to medical ethics. We believe that it is the natural extension of this philosophy of professionalism that most new efforts be formative rather than punitive. Although corrective mechanisms must be implemented for dealing with egregious behavior, our focus must be on finding new ways to recognize achievement in the moral dimension of health care and to encourage greater self-awareness and responsibility.

I hope that this summary of our work is helpful to you and to the Stritch School of Medicine. Enclosed find the drafts of our open letter to the LUMC community, our statement on professionalism, recommendations related to an integrated professionalism curriculum, and recommendations related to student maltreatment. A statement from our subcommittee considering a student honor code will be forthcoming.

Sincerely,

Mark G. Kuczewski, PhD
Chair, Ad Hoc Committee on Professionalism

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