Defining professionalism

The Program for Physician-Educators will address all six ACGME competencies during the May session. One of these competencies is professionalism, a quality that can be difficult to measure objectively. Jennifer Doyle, who is developing the professionalism piece of the Harvard Macy curriculum, said that although most graduate medical education programs address these competencies, they have not made explicit or objective the means for teaching or assessing them. “Professionalism in particular is an area that people have the most difficulty putting their finger on,” she said.

Doyle, director of educational development and evaluation in the Departments of Graduate Medical Education and Surgery at Beth Israel Deaconess Medical Center, is co-director of the Harvard Follow-Up study, which tracks the progress of Harvard Medical School (HMS) graduates. She points out that although unprofessional behavior may be recognized when it’s seen, the criteria for good professional conduct are not made explicit. However, recent data suggests that medical education programs must place a heavier emphasis on professionalism. “Among the major findings in the HMS follow-up study, which we’ve conducted for the past decade, is that those residency program directors who would not again select our graduates (only 6% of the total in the last ten years), cite breach of professional attitudes and behaviors as their primary concern,” says Doyle.

So what does professionalism mean with regards to physicians? According to Doyle, a few basic criteria exist: showing respect for all members of the health care team, demonstrating care and compassion for patients, answering their patients’ questions, willingly accepting constructive criticism. Further expectations may exist for individual specialties; for instance, a surgeon may demonstrate one aspect of professionalism by starting operations at their scheduled time.

The definition is clear enough, but is this competency the kind of thing that can be converted into an objective measure? ACGME wants residents to be evaluated by both their superiors through a global evaluation, and what is known as a 360 degree evaluation, which may gather feedback from nurses, patients, or other personnel who may be involved with the doctor as he goes about his or her duties. According to Doyle, peer evaluations are designed to identify practices or behaviors that demonstrate dishonesty or a lack of integrity.

Doyle said that HMS already does much to address the criteria, but ACGME will take professional development assessment to a new level. “Traditionally professionalism has been addressed in clinical training programs through role modeling,” says Doyle. “Residents are expected to replicate the behaviors they observe in their superiors and faculty. ACGME wants programs to make these expectations explicit for both faculty and trainees, and to develop criteria and methods to accurately and objectively assess them.”