Health Care Professionalism at a Glance

Jill Thistlethwaite, Judy McKimm

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118756355
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

Health Care Professionalism at a Glance offers accessible coverage of an increasingly important aspect of medical and health professional education. This concise text includes how to identify and develop professional behaviours, how they are assessed, and how to challenge unprofessional behaviours. Health Care Professionalism at a Glance:
•Provides a user-friendly and thought provoking overview of health care professionalism
•Introduces the main topics, key definitions and explores aspects relevant to learners and novice professionals
•Considers fundamental features of professionalism that students are expected to acquire as well as how they are taught, learned and assessed
•Includes summary boxes that highlight important points, reflection points, clinical cases and suggested further reading
•Includes references relevant to different countries' accrediting bodies This important new book will assist students in understanding the nature of professionalism, its assessment, and the implications for professional practice.

Part 1
Professionalism in context

Chapters

1. 1 What is professionalism?
2. 2 Health professionalism
3. 3 Brief history of the profession of medicine
4. 4 Becoming a professional
5. 5 Role of regulatory and professional bodies
6. 6 Fitness to practise and health for practice
7. 7 Revalidation and remediation
8. 8 Social media and the professional

CHAPTER 1
What is professionalism?

The bond between a man and his profession is similar to that which ties him to his country; it is just as complex, often ambivalent, and in general it is understood completely only when it is broken: by exile or emigration in the case of one’s country, by retirement in the case of a trade or profession. (Primo Levi, chemist and writer, in: Other People’s Trades 1985, trans. 1989)

In this introductory chapter we consider the nature of professionalism, its relationship to being a member of a profession and why all this is important for health care professionals.

Definitions

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Professionalism: the competence or skill expected of a professional — Oxford English Dictionary, 2nd edition, 2003.

‘It’s NOT the job you DO, It’s HOW you DO the job’ – anonymous at: http://clancycross.com/2009/03/26/professional-attitude/

A professional is a member of a profession – derived from the Latin word profiteri meaning to avow or profess; for example, many doctors profess the Hippocratic oath when they qualify.

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This all seems simple so far but the literature on professionalism, particularly in relation to medicine, has been expanding markedly in the last few decades and there is still much debate about what actually constitutes professionalism, particularly in relation to ‘professional’ and ‘unprofessional’ behaviour.

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One sociologist lists the following attributes of a profession:

• A skill set based on specialist knowledge
• Provision of training and education
• Means of testing for competence
• Organisation of members
• Adherence to a code of conduct
• The provision of an altruistic service not just for financial reward (Johnson, 1972)

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Putting this all together is the following contemporary definition from 2004:

A profession is ‘an occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism and the promotion of the common good within their domain’ (Cruess et al., 2004).

The attributes of professionalism are also related to their being a social contract between the profession and society. This contract gives the profession a degree of autonomy and self-regulation, but in return society expects that professionals are accountable to those they serve, their profession and society (Cruess et al., 2004).

The code of conduct — how to behave — is the essence of professionalism (see Chapter 20). Health professional training now introduces students to the code of their specific profession, which includes ethical and legal requirements. Professionalism is taught through formal and informal activities, and students are expected to learn the correct way to behave. Moreover, professionalism and professional behaviour is now assessed through a variety of means.

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A professional is

‘…a man who can do his job when he doesn’t feel like it. An amateur is a man who can’t do his job when he does feel like it.’ James Agate (1877—1947), British diarist and critic ‘a reflective practitioner who acts ethically’. Hilton and Slotnick (2005)

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Think of three examples of professional behaviour and three examples of unprofessional behaviour. How do you make the distinction based on the definitions above? Can students behave unprofessionally? Is unprofessional behaviour likely to vary for students of different professions?

Professionalism courses

Can professionalism be taught? Well, you will certainly find teaching related to professionalism at university.

The most common components of professionalism courses, which are often called personal and professional development (PPD), are

• Ethics and the duties of a health professional
• The law applied to health professional practice
• The role of the regulatory body (e.g. for medicine — the General Medical Council in the United Kingdom and the Australian Health Professional Regulatory Authority and the medical boards in Australia; for nursing — the Nursing and Midwifery Council in the United Kingdom and the Nursing and Midwifery Board in Australia)
• Communication (not only with patients but also with colleagues/other health professionals; and not only oral but also written and online)
• Teamwork and collaboration
• Self-care
• Cultural awareness and cultural competence
• Reflective practice
• Patient safety
• Leadership

There may also be discussions about professional attributes such as altruism, empathy and compassion — raising the question of whether these can be taught and indeed learned. Some schools include teaching on professional autonomy, evidence-based practice and values-based practice under ‘professionalism’.

CHAPTER 2
Health professionalism

In this chapter, we provide examples of how professionalism is discussed in health professional charters and lists of competencies. A competency is an observable ability that develops through stages of expertise from novice to expert. A more recent term is entrustable professional activity (EPA): a key task of a profession that can be entrusted to an individual who possesses the appropriate level of competencies (Frank et al., 2010). There is not enough space to consider each health profession, but the following gives an idea of the theme and flavours of professionalism around the globe.

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Compare the items and attributes in the various lists. What are the similarities and differences, and what might account for these? Are there any that surprise you?

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Medicine

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Medical Professionalism in the New Millennium: A Physician’s Charter (American Board of Internal Medicine — ABIM, 2002)

Medical professionalism is underpinned by

Three fundamental principles

• Primacy of patient welfare
• Primacy of patient autonomy
• Principle of social justice

Ten professional responsibilities

• Professional competence
• Honesty with patients
• Patient confidentiality
• Maintaining appropriate relationships with patients
• Improving quality of care
• Improving access to care
• Just distribution of resources
• Scientific knowledge
• Maintaining trust by managing conflicts of interest
• Professional responsibilities

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The General Medical Cou...