Putting the Professionalism Charter Into Practice in GME

Harry R. Kimball, MD, MACP

IHI/ACGME Conference on Professionalism

New Orleans, Louisiana

December 1, 2003

ABIM Foundation ACP Foundation

European Federation of Internal Medicine

ABIM FoundationTroy Brennan, Project Chair

Jordan Cohen

Harry Kimball

Neil SmelserLinda Blank, Project Staff

European Federation of Internal Medicine

Gunilla Brenning

Chris Davidson

Philippe Jaeger

Alberto Malliani

Hein Muller

Daniel Sereni

Eugene SutoriusACP Foundation

Robert Copeland

Risa Lavizzo-Mourey

Walter McDonald

Special Consultants

Sylvia and Richard Cruess

Jaime Merino

Project Members

Questions

• Why do we need a charter on medical professionalism today?

• Can the charter make a difference to practicing physicians, residents and medical students, and to patients?

• How will its impact and effectiveness be measured?

THE PHYSICIAN CHARTERAnnals of Internal Medicine, The Lancet, February 2002

Three Fundamental Principles

• Primacy of Patient Welfare

• Patient Autonomy

• Social Justice

THE PHYSICIAN CHARTER

A Set of Responsibilities and Commitments to:

1. Professional Competence2. Honesty with Patients3. Patient Confidentiality4. Maintaining Appropriate Relations With Patients5. Improving Quality Care6. Improving Access to Care7. Distribution of Finite Resources8. Scientific Knowledge9. Maintaining Trust By Managing Conflicts of Interest10. Professional Responsibilities

• Lifelong professional development

• Maintenance of certification

Commitment to Professional Competence1

Examinations

• Impaired physicians (self-regulation)

• Patient’s right to refuse treatment (patient autonomy)

• Abuse of power (inappropriate physician-patient relationships)

• Pregnancy/HIV (confidentiality)

• Work collaboratively to:– Reduce medical error– Increase patient safety– Minimize overuse – Optimize outcomes of care

• Help develop and implement better measures of quality health care

Commitment to Improving Quality of Care5

Quality Improvement Practicum for IM Residents and Faculty

• Collaboration: ABIM Foundation, ABIM, and Alliance for Academic Internal Medicine

• Selected Residency Programs

• Preventive Cardiology Practice Improvement Module (PIM)

• Tests applicability as educational experience in quality assessment and improvement

9 Maintaining Trust by Managing Conflicts of Interest

• Recognize the existence of many opportunities to pursue private gain

• Disclose all conflicts of interest involving professional activities

• Importance of reflective practice

10 Commitment to Professional Responsibilities

• Participate in the processes of self-regulation

• Assist in establishing educational and standard-setting activities

• Accept external scrutiny of professional performance

ABIM Strategies for Evaluating Professionalism in GME

1. Examinations

2. Program Director Ratings

3. Structured Evaluations (Mini-CEX)

4. Peer and Patient Ratings

5. Professionalism Portfolios

Program Director Ratings

Annual evaluations of professionalism along with other competencies, 9 point scale

• superior

• satisfactory

• marginal

• unsatisfactory

2

Professionalism Ratings (1990-1998)

Unsatisfactory Ratings: N= 758

74% men Age: 31.647% USMG 53% IMG

Outcomes: 381 Left internal medicine 377 Completed training

269 Attempted certification193 Passed

Structured Evaluations in Professionalism:

New Generation X Mini-CEX3

Quality Improvement

Plan

Quality Improvement

Plan

ABIM Scores Report

10 Peers

25 Patients

Self-Assessment

ABIM Scores Report

10 Peers

25 Patients

Self-Assessment

Select raters; Distribute surveys; Use interactive

voice response system to complete

Patient and Peer Assessment4

Professionalism Portfolios

• show evidence of competence

• promote self-reflection and self-awareness

• stimulate self-directed learning

• foster a healthy professional lifestyle that leads to achieving long-term career goals

A promising strategy to:

5

The Competent Physician

David Leach and the ACGME provide the following definition:

"The competent physician habitually incorporates three elements into daily work: evidence-based medicine, patient-centered care, and reflective

practice."

The Charter on Medical Professionalism reaffirms these elements and provides a contemporary framework for both action and realization.