Consider for a moment that you are a scout for a Major League Baseball team. There’s a promising prospect, a pitcher, from Anytown, USA, and you’re in the bleachers watching him on a summer afternoon. His pitching mechanics are sound. He has three, maybe four, pitches in his repertoire, and his fastball has great velocity. Looks like a “can’t miss” prospect.
After a conversation with his coach, you’re reconsidering. Your future All Star doesn’t show up to practice on time. And on days when he’s not pitching, he’s checked out, not interested. Doesn’t seem like a team player. You put it straight to the coach: “Do you think this kid can make it to the big leagues?” The answer gives you pause: “He has all the tools, but the way he conducts himself doesn’t give me confidence.”
In medicine, we have a word for “the way he conducts himself”: professionalism. It’s not a new concept. In 2002 the Accreditation Commission on Graduate Medical Education (ACGME) launched the Outcome Project. The question they sought to answer was pretty simple: what attributes or competencies do we require in our doctors? ACGME outlined six competencies, among them professionalism.
Recently I attended the Society of Teachers of Family Medicine (STFM) Medical Student Education conference in Nashville. Among a number of great sessions, a session on professionalism* was one of the most thought-provoking. No doubt family medicine physicians—who deal with patients and families every day, face to face—place a big emphasis on his or her conduct.
It’s important to recognize that ACGME put professionalism on par with medical knowledge—what’s on the test—in its outline of the competencies. Work within the past decade has demonstrated clear connections between instances of unprofessional behavior as a medical student and unprofessional behavior as a physician.
Most institutions, including AUC, have professionalism components woven throughout the formal and informal curriculum, as well as assessment measures. The professionalism session at the STFM conference was particularly effective at providing clarity around specific components of professionalism and using examples translating medical student behaviors into physician behaviors. When confronted about lapses in professionalism, students sometimes wonder why their lapse was a big deal. The answer is simple: these behaviors, when uncorrected, tend to persist through residency training and into practice as a physician.  
Let’s look at three facets of professionalism: honesty, professional responsibility, and competence. I’ve seen dishonesty take many forms in medical students. One common occurrence is signing in (or having someone else sign you in) and not attending an educational session. Saying you were someplace that you were not is inherently dishonest, and this isn’t a trivial issue. Believe it or not, this became a huge issue for physicians in teaching hospitals when Medicare started noticing that supervising physicians signed charts saying they were present in an encounter with a resident when they were actually not there. A resident provided the patient care and the attending physician signed the chart, allowing the physician or physician’s employer to bill Medicare. The consequence was that many teaching hospitals paid millions to settle these suits and individual physicians were disciplined in various ways.
Professional responsibility means many things, but one element of this doing what is required of you. In my career, I’ve had the opportunity to watch students become residents and then become practicing physicians. Some students struggle with completing what is expected, especially if that something just doesn’t seem important. Perhaps that something is an assignment worth relatively few points, and so therefore seems irrelevant. Just one example: the students who miss deadlines to turn in paperwork for a specific hospital, putting their rotation in jeopardy.
Fast forward to when these students become physicians. These are the physicians who complete charts in 48 hours instead of the standard 24. These are the physicians who skip mandatory educational sessions on topics like harassment or fail to attend a required electronic health record training session. There was perhaps a time when this behavior was tolerated among physicians, but as more physicians become employees, the misconception that physician status allows you to bend the rules is diminishing. In the above examples, I’m referring to behavior that is both intentional (“I shouldn’t have to do this so I’m not going to”) and unintentional (“I am disorganized and can’t remember everything that I am supposed to do”). Either way, the point is that you cannot effectively function as a physician if you cannot complete your professional responsibilities.
The final component I want to touch on is competence. Competence means having a knowledge base and polished skills, but it also means having the discipline to bring your peak performance every day, every time. You have to throw strikes in the 90s every time you pitch, not just when the scouts are watching. Your peak performance is influenced by your life habits. As a medical student, if you get too little sleep or come to class with a hangover, you don’t learn as well, and if you are seeing patients, you don’t perform as well. This isn’t trivial either: as your level of responsibility and thereby your ability to cause harm to patients increases, your life habits will affect other people’s lives. I hope that thought is sobering.
* Facing Students’ Professionalism Problems: Strategies for Feedback and Reflection
Robin DeMuth, MD, Julie Phillips, MD, MPH, Michigan State University, East Lansing, MI; Carol Hustedde, PhD,
University of Kentucky, Lexington, KY; Gretchen Dickson, MD, MBA, University of Kansas School of Medicine-Wichita

Dr. Heidi Chumley

Posted February 07, 2014 01:02 PM

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