University of Virginia School of Medicine
Surgery Conference Room, 4:00 p.m.
Present (underlined) were: Reid Adams, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary)
- Neuroscience Curriculum Review scheduled for today has been postponed at the request of the Neuroscience Course Directors.
- Professionalism (Nancy Payne). Much emphasis has been placed on professional behavior over the course of the past several years, with national effort given to create a comprehensive definition of professionalism. Like other skills in medical education, professionalism is learned through the formal (syllabus), informal (role-modeling), and hidden (underlying framework) curriculums. Identifying informal and hidden curricular elements is difficult due to the implicit nature of these components.
National organizations such as the National Board of Medical Examiners (NBME), AAMC and ABIM have composed the most widely used definitions of professionalism. In this new era, medical universities are adopting the national definitions of professionalism and highlighting the importance of teaching and evaluating this core skill.
Although UVA identified professionalism as one of its twelve learning objectives for medical student education in 1996, the difficult task of isolating this curricular component has inhibited its full evaluation. This project was designed in order to assist the Curriculum Committee in determining whether teaching of professionalism is adequately addressed in medical education at UVA. The NBME definition of professionalism has been selected by the medical school to study student learning and perform student evaluation.
NBME definition of Professionalism
Honesty and integrity
Caring, compassion and communication
Respect for others
Respect for differences
Responsibility and accountability
Excellence and scholarship
Knowledge of and skills related to professionalism
Curriculum evaluation reveals that the skill of professionalism is taught throughout the four years of medical training explicitly in the formal clinical curriculum. Implicit instruction in this skill occurs through the informal and hidden curriculums. Examples of elements that bridge the informal and hidden curriculums with the formal medical school curriculum include: the White Coat Ceremony, student professionalism performance feedback forms, the Humanism in Medicine Honor Society, and a Healer’s Art course.
Additional teaching within the informal curriculum has been elicited by student response to a clerkship survey. Preliminary data from clerkship students collected during the 2004-2005 pilot year reflect that students observe professional behaviors while on their clerkships. Students most cite communication skills of residents as an exemplary model of professionalism. However, feedback from students implies that there are breaches of professionalism by peers, residents, and faculty during their clerkship experience, notably in the areas of confidentiality, disrespect of other professionals, and offering sub-optimal patient care.
Review of faculty development programs and policy manual updates overarching the health care system reveals hidden curricular elements emphasize professionalism through CME (continuing medical education) and the creation of new institutional policies. Additionally, resources and evaluation activities have been dedicated to this skill through institutionally driven research grants.
The formal, informal, and hidden curriculums at UVA address the skill of professionalism. The formal instruction given to the skill of professionalism is not necessarily where students learn the most about professional behavior. As students witness resident and faculty role-modeling of professional and unprofessional behaviors and become attuned to the messages medical schools and hospitals give with respect to institutional policies, resource allocation decisions, and post-graduate educational activities, they learn from informal and hidden curriculums.
Even with formal curricular emphasis on professional behaviors, there is concern that curriculums may teach our students inadequately when the students’ clinical experience teaches them unprofessional behaviors. The learning of professionalism can be described along a continuum, with positive and negative influences sharpening the development of this skill. The attainment of professional standards should be sustained and the attrition that results from negative influences should be minimized.
Next steps of this project include further collection of data for curriculum evaluation, raising awareness of and discussion of planned interventions to address uncovered issues of concern.
The Committee responded that instruments for assessing professional competency should be developed and professional competency be measured.
Mechanisms for anonymous reporting by students of unprofessional behavior were discussed.
A poster with the above information is being prepared and will be placed outside the Health Sciences Library in the near future.
- Clinical Connections. (Reid Adams) Reid Adams updated the Committee on recent improvements to the Clinical Connections course. The Clinical Conversations have been suspended temporarily and will be returning in a new format in the future. One CC in February at this point is still available for a new topic. The Curriculum Committee noted that cultural literacy is very important and might best be covered in a CC session. Reid Adams noted that a person to run this program will need to be recruited. Fern Houck in General Medicine, Norm Oliver or Ross Isaacs were suggested as possible candidates with help from Ann Chapin who already organizes people from different cultures to meet with PoM1 students. Having Anne Chapin involved would avoid overlap with PoM1 and help deliver a fresh approach. If this can be put together before February, the Curriculum Committee heartily endorses this program. Reid Adams would like to try to move all the sessions back to Fridays next year if possible so that the Nursing School could be included.
Donald J. Innes