Journal of Dental & Oro-facial Research Vol 12 Issue 1 Jan 2016 JDOR

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REVIEW

PROFESSIONALISM IN HEALTHCARE

EDUCATION

Shwetha KM1*, Sivaranjani Gali 2 *Corresponding Author Email: shwethskm@gmail.com

Contributors:

1 Reader,

PSG-FRI fellow 2014,

Department of Public Health

Dentistry, FDS, MSRUAS,

Bangalore

2 Reader, Department of

Prosthodontics, FDS, MSRUAS,

Bangalore

ABSTRACT

As healthcare professionals, we occupy a respectable status in the society

due to the responsibility and accountability that our health profession demands.

Thus, there is a greater need to incorporate all the required competencies into our

educational curriculum for students to provide quality health care. One of the core

competencies that must be instilled in our students is Professionalism. Institutions

can adopt such core competencies subject to the mandatory rules of the regulatory

bodies and health professionals can teach only if included in our curriculum.

Therefore, this paper discusses about components of professionalism, teaching and

assessment methods for instilling professionalism among students.

INTRODUCTION:

Health care professionals are given certain privileges in the

society due to the nature of their contributions (1). Doctors

are characterised by their strong commitment towards

patient’s well-being, high standards of ethical conduct, their

mastery in learning knowledge and acquiring skills, and self-

regulation (2). Professionalism is one of the competencies a

healthcare professional should and must possess. In fact,

Accreditation Council for Graduate Medical Education

(ACGME) suggests teaching of professionalism to students

during their training period (3). The objective of this paper

is to emphasise on professionalism in health care, its

components, methods/ ways of teaching and assessment.

“Professionalism” is derived from the Latin professio or

public declaration. A definition of profession is “a calling

requiring specialized knowledge and often long and

intensive preparation including instruction in skills and

methods as well as in the scientific, historical, or scholarly

principles underlying such skills and methods, maintaining

by force of organization or concerted opinion high standards

of achievement and conduct, and committing its members to

continued study and a kind of work which has for its prime

purpose the rendering of a public service”. Professionalism

is constituted by the goals, attributes and behaviours of

profession (4). Its attributes are communication, empathy,

integrity, compassion, responsibility, respect, duty, altruism,

self-regulation, ability to understand limitations and eager to

improve the skills and knowledge (5–8) (Fig 1).

Professionalism is concerned about the moral aspects such

as norms, values and behaviour of a doctor during their

practice (9). Professionals must render quality care to

patients above their self-interest. Such attitudes and

behaviours are not taught in a regular medical or dental

curriculum, but were part of hidden curriculum which means

it’s not part of formal education (5,10–14).

Fig.1 Attributes of professionalism (Arnold and Stern 2006)

The emphasis is to include professionalism in routine

curriculum of undergraduate and postgraduates, as it is

considered as second order competence (9). As

professionalism is demonstrated while practicing our core

competency for patient care (15) which has to be taught

during their training, students learn to practice with

commitment and accountability. Students must also learn to

balance between financial aspects, the ethical and moral

values (16). As health care professional educators, we must

reflect upon the various competences we are equipping our

graduates to meet health care needs and expectation of

society (17). First and foremost, teachers of health

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profession education must be clear as teaching

professionalism is not as simple as teaching cognitive and

clinical skills.

Teaching professionalism

The classic triad of professionalism consists of a high level

of intellectual and technical expertise, autonomy in the

practice and regulation of the discipline, and a commitment

to public service (18). The core competency of intellectual

and technical expertise is taught through a well-structured

curriculum. But there is no formal and informal training

regarding discipline, the humanism attitudes and behaviours.

The Accreditation Council for Graduate Medical Education

(ACGME) accepts professionalism as one of the

competencies to be acquired by the medical students and

have to be taught during students training years, but it’s a

challenge to teach as regular subjects. It’s like teaching them

how to swim or ride the bicycle; it will be learnt by practice

(3,19). Nevertheless it should start as early as possible and

followed till they complete the graduation.

Professionalism includes non-cognitive skills(5) that can be

taught using Dreyfus adult skill acquisition model as

suggested by David Leach (19). This model explains the

stages a novice acquire skills to become an expert (fig.

2).The objectives, teaching learning methods and the

assessment can be suggested like a blueprint by the

governing bodies or university. Anne Stephenson et al

suggested three key aims to be achieved during the medical

school. One, is to understand the origins of professionalism

and the responsibilities, second to instil the professional

behaviours in medicine and third, to understand the concept

and demonstrate in their work and willingness to continue to

develop their skills (18).

Teaching begins in the institution by defining what is

expected from the student and the expected behaviours and

non-expectable behaviours as policy statements (5). Having

Fig. 2 Based on five-stage model of adult skill acquisition

Dreyfus (26)

the curriculum and policies helps teachers to focus on

teaching professionalism to students. The faculty

development programs for teachers should be conducted to

train them about the importance, teaching methods and

assessment of students for professionalism. The support

from other disciples such as sociology, philosophy, political

science and other humanities can also be planned (18).

Innovative methods in large or small group teaching,

reflective or experiential learning methods or role plays,

group discussions based on clinical scenario or case

vignettes, standardised patients, can be used (20).

Klemenc-Ketis et al used cinemeducation as method to teach

professionalism. The authors concluded that controlled

environment of movies enabled students to explore values

and attitudes without affecting their personal integrity

through a qualitative study. The other methods such as use

of drama/theatre, observing the doctors in the wards are also

suggested (11). These methods can be used during

classroom, clinics, wards, field programs and workshops.

Good role modeling is an important method that students

follow and remains a cornerstone in education. Therefore

educators should personify the values, attitude and other

professional behaviours in their daily routine as students will

be observing and imitating them (18).

Assessing students for professionalism

A great medical educationalist Miller said “assessment

drives learning” (21). Students read and learn merely for the

purpose of examination. Hence assessment is an important

aspect of educational spiral. As Cob’s once said "We get

what we assess, and if we don't assess it, we won't get it".

Assessing professionalism in students helps to ensure the

basic values, etiquette, attitudes and behaviours that are

expected from a health professional.

Formative assessment is one of the methods suggested to

assess professionalism. This should align with objects and

methods used for teaching and learning. The assessment and

feedback in the early stages helps to develop and instill the

expected behaviours and the opportunity to improve

Fig3. Miller’s pyramid for assessment

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Table 1 Examples linking professional values with the behaviour and teaching assesmnet

and internalise. The assessment can be based on the

conceptual model of clinical competence by Miller (9,22)

(Fig. 3).

Written tests, multiple choice questions, reflections on the

scenarios, role-play and feedback, portfolios, standardised

patients feedback, Mini-Clinical examination (CEX),

Professionalism Mini-Evaluation Exercise (P-MEX), patient

satisfaction reports and others workplace

assessment methods can be used. As there are multiple

aspects of the professionalism with respect to students

behaviour 360 degree assessment can be used or multiple

methods can be used for assessment (5,8,9,16,23–25).

Multiple assessment methods can be used to assess students

depending on the defined learning outcome. (Table 1).

Conclusion: Our students must be equipped with the

competencies that are expected from society.

Professionalism was part of hidden curriculum and the need

for its inclusion in values, morals, attitudes and behaviours

must be followed by a health professional.

Acknowledgements:

We would like to acknowledge Dr.K.Pushpanjali, Registrar

Academics, MSRUAS, FAIMER fellow 2013 for her

valuable inputs and all the faculty and PSG-FRI,

Coimbatore fellows for providing the resources.

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