Fellows’ in intensive care medicine views on professionalism and how they learn it
Walther N. K. A. van Mook, Willem S. de Grave, Simone L. Gorter, Arno M. M. Muijtjens, Jan Harm Zwaveling, Lambert W. Schuwirth, Cees P. M. van der Vleuten
Original
Volume 36,
Issue
2
/
February ,
2010
Pages 296 - 303
Abstract
Introduction
The emphasis on the importance of professionalism in a recent CoBaTrICE-IT
paper was impressive. However, insight into the elements of professionalism as perceived
relevant for intensivists from the fellows’ view, and how these are taught and learned, is limited.
Objectives and methods
A nationwide study was performed in 2007–2008. All ICM fellows
(n = 90) were sent a questionnaire containing the following questions regarding training in professionalism (7-point Likert scale (1 = very inadequate, 7 = very adequate)): which are the elements perceived to be important in intensivists’’ daily practice (38 items, cat. I)? Which methods of learning and teaching are recognised (16 items, cat. II)? Which methods of teaching and learning are considered especially useful (16 items, cat. III)? Finally, the perceived quantity and quality of formal and informal learning methods, as well as the responsible organisational body was studied. Data were analysed using SPSS 15.0.
Results
Response was 75.5 % (n = 68), mean age 34 years. Regarding Elements, scores on virtually all items were high. The factor ‘striving for excellence’ explained half the variance. Two other aspects, ‘Teamwork’ and ‘Dealing with ethical dilemmas’, were identified. Regarding Methods, three dimensions, ‘formal curriculum’’, ‘private and academic experiences’ and ‘role modelling’, proved important. The factor ‘formal curriculum’ explained most of the variance. Regarding Usefulness the same factors, now mainly explained by the factor Private and academic experiences, emerged with variance. In both categories the items ‘observations in daily practice’ and ‘watching television programmes like ER and House’ were the highest- and lowest-scoring items (5.99 and 5.81, and 2.69 and 2.49, respectively). Mean scores regarding the quantity of formal and informal teaching were 4.06 and 4.58 (range 1.841 and 1.519). For the quality of teaching, the figures were 4.22 and 4.52 (range 1.659 and 1.560, respectively). 54 suggestions for improvement of teaching were documented. The need for some form of formal teaching of professionalism aspects as well as for feedback was most frequently mentioned (n = 19 and 16). The local training centres are considered and should remain pivotal for teaching professionalism issues (n = 17 and 28).
Conclusions
Almost all elements of professionalism were considered relevant to
intensivists’ daily practice. Although formal teaching methods regarding professionalism aspects are easily recognised in daily practice, learning by personal experiences and informal ways quantitatively plays a more important, and more valued role. Qualitative comments, nevertheless, stress the need for providing and receiving (solicited and unsolicited) feedback, thereby requesting expansion of formal teaching methods. The local training centres (should continue to) play a major role in teaching professionalism, although an additional role for the (inter)national intensive care organisations remains.
Keywords
References
- Stephenson AE, Adshead LE, Higgs RH (2006) The teaching of professional attitudes within UK medical schools: reported difficulties and good practice. Med Educ 40:1072–1080
- van Mook W, de Grave W, Wass V, O’Sullivan H, Zwaveling J, Schuwirth L, van der Vleuten C (2009) Professionalism: evolution of the concept. Eur J Int Med 20:e81–e84
- Papadakis MA, Teherani A, Banach MA, Knettler TR, Rattner SL, Stern DT, Veloski JJ, Hodgson CS (2005) Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med 353:2673–2682
- Papadakis MA, Arnold GK, Blank LL, Holmboe ES, Lipner RS (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards. Ann Intern Med 148:869–876
- Lee AG, Beaver HA, Boldt HC, Olson R, Oetting TA, Abramoff M, Carter K (2007) Teaching and assessing professionalism in ophthalmology residency training programs. Surv Ophthalmol 52:300–314
- Edelstein SB, Stevenson JM, Broad K (2005) Teaching professionalism during anesthesiology training. J Clin Anesth 17:392–398
- Rowley BD, Baldwin DC Jr, Bay RC, Cannula M (2000) Can professional values be taught? A look at residency training. Clin Orthop Relat Res 378:110–114
- The Royal College of Physicians and Surgeons in Canada. http://rcpsc.medical.org/canmeds/index.php. Accessed 10 October 2006
- Medische Vervolgopleidingen.nl M. http://www.medischevervolgopleidingen.nl/pages/content.aspx?content=10010000000029_2_10000000001651&contentcode=competentiesspecialist. Accessed 10 October 2006
- American College for Graduate Medical Education (1999) ACGME Outcome Project enhancing residency education through outcomes assessment: general competencies. Accessed 13 February 2006. http://www.acgme.org/outcome/comp/compFull.asp
- Bion JF, Barrett H (2006) Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 32:1371–1383
- Klein EJ, Jackson JC, Kratz L, Marcuse EK, McPhillips HA, Shugerman RP, Watkins S, Stapleton FB (2003) Teaching professionalism to residents. Acad Med 78:26–34
- Brownell AK, Cote L (2001) Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med 76:734–737
- Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334
- Nunnaly J (1978) Psychometric theory, 2nd edn. McGraw-Hill, New York. ISBN: 0070474656
- SPSS Inc. (2006) SPSS 15.0.0
- Wagner P, Hendrich J, Moseley G, Hudson V (2007) Defining medical professionalism: a qualitative study. Med Educ 41:288–294
- Ephgrave K, Stansfield RB, Woodhead J, Sharp WJ, George T, Lawrence J (2006) The resident view of professionalism behavior frequency in outstanding and “not outstanding” faculty. Am J Surg 191:701–705
- Ratanawongsa N, Bolen S, Howell EE, Kern DE, Sisson SD, Larriviere D (2006) Residents’ perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements. J Gen Intern Med 21:758–763
- Page DW (2006) Professionalism and team care in the clinical setting. Clin Anat 19:468–472
- van Luijk S, van Oosterhout W, van Mook WNKA (2009) Professionaliteit: het toetsen en leren van de professionele rol. Neth J Med Educ 28:107–118
- van Mook W, van Luijk S, O’Sullivan H, Wass V, Zwaveling J, Schuwirth L, van der Vleuten C (2009) The concepts of professionalism and professional behaviour: conflicts in both definition and learning outcomes. Eur J Int Med 20:e85–e89
- Horton R (1999) The uses of error. Lancet 353:422–423
- Charap M (2004) Reducing resident work hours: unproven assumptions and unforeseen outcomes. Ann Intern Med 140:814–815
- Stern DT, Papadakis M (2006) The developing physician—becoming a professional. N Engl J Med 355:1794–1799
- Hafferty FW, Franks R (1994) The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 69:861–871
- Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL (1998) Attributes of excellent attending-physician role models. N Engl J Med 339:1986–1993
- Branch WT Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T (2001) The patient–physician relationship teaching the human dimensions of care in clinical settings. JAMA 286:1067–1074