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 Is a core competency for physicians and

medical students

 Professional Competence
› Is the habitual and judicious use of
communication, knowledge, technical skills,
clinical reasoning, emotions, values, and
reflection in daily practice for the benefit of
the individual and community being served
 Competence

› is developmental and content-


dependent

› Progresses with increased training


and it varies for different disciplines
and situations
1. Subordinate self-interest
2. Adhere to high ethical/moral standards
3. Respond to societal needs
4. Evince core humanistic values
5. Exercise accountability
6. Demonstrate continuing commitment to
excellence
7. Deal with complexity
8. Reflect on actions and decisions
Acad Med 2000; 75;612
 Personal/intrinsic attributes
1. Ethical practice
2. Reflection & self-awareness
3. Responsibility and accountability
 Co-operative attributes
4. Respect for patients
5. Teamwork/working with others
6. Social responsibility
Medical Education 2005; 38:58
 Professionalism and Ethics teaching,
most often, should occur in the
preclinical years of medical school.

 Each clinical discipline should address


the ethical and legal issues of particular
relevance to that discipline, assess the
students in professionalism as they would
for any other aspect of teaching and
encourage students to present problems
which they have personally encountered
in their course
 Physicians encounter a broad range of
‘everyday’ ethical challenges, from
truth-telling to working in non-ideal
conditions

 Studies of postgraduate medical training


offer fascinating insights into the
processes of professionalization and the
moral development of junior doctors
[Bosk C, 2003; Casell J.,2005]
1) Concern over truth telling
2) Respecting patient’s wishes
3) Preventing harm
4) Managing the limits of one’s
competence
5) Addressing performance of others
perceived to be inappropriate

Rosembaum, et al, 2004


Type of Ethical Issue Specific examples

To patients and relatives about


Telling the truth the diagnosis and prognosis

To patients about lack of


experience

To consultants about tasks


performed

To colleagues about a


patient’s condition when
seeking tests

The unique positions in the medical hierarchy and their dual


roles as clinicians and learner bring additional problems to the
medical trainees.
Type of Ethical Issue Specific examples

Respecting patient’s wishes


Respecting patient’s
about treatment, including
autonomy at the end of life

Maintaining confidentiality

Seeking informed consent

To respect patient autonomy, doctors must provide


information without manipulation or coercion.
Type of Ethical Issue Specific examples

Dealing with potential


Preventing harm
harm to patients
associated with their
treatment

Avoiding harm to
patients when involving
them in the educational
process

Duty of non-maleficence can be difficult to fulfil when


involving the patient in educational process.
Type of Ethical Issue Specific examples

Coping with feeling


Managing the limits of
inadequately prepared for
one’s competence their responsibilities

Negotiating lack of
supervision/role modelling
by superiors

Making mistakes
Type of Ethical Issue Specific examples
Dealing with peers’
mistakes/incompetence
Addressing the
inappropriate Conflict between view of junior
doctors and superiors –subjugating
behaviour of others own opinions and values to superior’s
demands

Observing unethical behaviour of


others

Demeaning humour about patients

Compromised superiors
Superiors handing risky tasks down the
hierarchy

Dealing with verbal/physical abuse


by patients and superiors
Type of Ethical Issue Specific examples

Ability to treat the family


Conflict of interest
and friends

Offers of gifts or
hospitality from drug
companies
Type of Ethical Issue Specific examples

Dealing with sexual


Setting interpersonal
advances or romantic
boundaries with intentions
patients
Treating disliked, difficult,
or dangerous patients

Controlling compassion
Type of Ethical Issue Specific examples

Dealing with transience


Impact of working
conditions Working long hours

Feeling unsupported by
hospital administration

Working when unwell or


exhausted

Lack of cover for absent


colleagues
Type of Ethical Issue Specific examples

 Access to killer exams


Cheating
False monitoring
Type of Ethical Issue Specific examples

 Biased towards a person


Misplaced loyalty
or institution, so that you
defend the person or
institution for wrong
reasons

A dangerous thing - not only


does it belittle one’s morally, it
leaves one completely at the
mercy of the people benefiting
from one’s misplaced loyalty.

 Code of Silence
 An important issue in relation to Ethics
and Professionalism training in the clinical
years of medical school is the effect of
the informal, or “hidden” , curriculum

 This is a day-today learning that takes


place in the clinical setting that is not
under the control of the superiors and/or
the clinical coordinator
 Did something unethical ………………………….. 58%
 Misled a patent …………………………….. ……… 52%
 Either did something or misled a patient……….. 80%
 Heard physicians refer to pts derogatorily ……... 98%
 Witnessed unethical behaviour by other team
members ………………………………………….. 61%
 Felt like accomplice ……………………….54%
 Felt bad about something they did as CC ……... 67%
 Felt at least some ethical principles eroded …… 62%

 CC who witnessed unethical episode: more likely to


act improperly for fear of poor evaluation or to fit in
with the team
 Medical educators should “recognize
that professionalism arises from long
term combination of experience and
reflection on the experience, provide
stage appropriate experiences for these
so-called proto-professionals, and
maximize opportunities for attainment
and minimize inappropriate attrition such
as occurs in the hidden curriculum.”

Hilton & Slotnick


Med Educ. 2005
The most effective way of
teaching Professionalism is for
the instructors to model
appropriate behaviour and
impose a consistent policy of
ZERO tolerance for
unprofessional behaviour.
Duff P. Obstet Gynecol, 2004

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