The professionalism curriculum as a cultural change agent in surgical residency education

BackgroundTeaching professionalism effectively to fully engaged residents is a significant challenge. A key question is whether the integration of professionalism into residency education leads to a change in resident culture.MethodsThe goal of this study was to assess whether professionalism has taken root in the surgical resident culture 3 years after implementing our professionalism curriculum. Evidence was derived from 3 studies: (1) annual self-assessments of the residents' perceived professionalism abilities to perform 20 defined tasks representing core Accrediting Council on Graduate Medical Education professionalism domains, (2) objective metrics of their demonstrated professionalism skills as rated by standardized patients annually using the objective structure clinical examination tool, and (3) a national survey of the Surgical Professionalism and Interpersonal Communications Education Study Group.ResultsStudy 1: aggregate perceived professionalism among surgical residents shows a statistically significant positive trend over time (P = .016). Improvements were seen in all 6 domains: accountability, ethics, altruism, excellence, patient sensitivity, and respect. Study 2: the cohort of residents followed up over 3 years showed a marked improvement in their professionalism skills as rated by standardized patients using the objective structure clinical examination tool. Study 3: 41 members of the national Surgical Professionalism and Interpersonal Communications Education Study Group rated their residents' skills in admitting mistakes, delivering bad news, communication, interdisciplinary respect, cultural competence, and handling stress. Twenty-nine of the 41 responses rated their residents as “slightly better” or “much better” compared with 5 years ago (P = .001). Thirty-four of the 41 programs characterized their department's leadership view toward professionalism as “much better” compared with 5 years ago.ConclusionsAll 3 assessment methods suggest that residents feel increasingly prepared to effectively deal with the professionalism challenges they face. Although professionalism seminars may have seemed like an oddity several years ago, residents today recognize their importance and value their professionalism skills. As importantly, department chairpersons report that formal professionalism education for residents is viewed more favorably compared with 5 years ago.     

Professionalism and the role of medical colleges

BackgroundThere has been substantial interest and emphasis on medical professionalism over the past twenty years. This speaks to the history of the medical profession, but increasingly to a broader understanding of the importance of socialisation and professional identity formation.MethodA literature review was undertaken of professionalism and the role of professions and medical professional organisations.ResultsA key outcome has been the recognition that medical professionalism must be actively taught and assessed. Substantial effort is required to improve the educational environment, so that it nurtures the development of professionalism within the work-place.Although medical colleges have been prominent in identifying and progressing the recent developments within professionalism there is still much to be done to deliver fully on the societal contract between the public and the profession.There are key gaps to address, particularly with regards to self-regulation, civil behaviour and effective leadership and advocacy.ConclusionMedical colleges need to take direct responsibility for the professionalism of their members. The expectations of the community are increasingly clear in this regard.     

Improving professionalism: making the implicit more explicit

PURPOSE: Professionalism is one of the most challenging of the Accreditation Council for Graduate Medical Education Competencies to define, teach and evaluate. At University of Washington we assessed whether defining professionalism, and training faculty and residents in the evaluation process would improve professional behavior. MATERIALS AND METHODS: In 2003 the Accreditation Council for Graduate Medical Education Global Resident Competency Rating Form was distributed to faculty after each rotation to evaluate residents. The project included all 16 residents and 18 clinical faculty during a total of 15 rotations for 3 years at 4 Seattle area hospitals. After 21 months a training lecture on professionalism was presented to faculty and residents. Following this intervention all trained faculty completed a Graduate Medical Education Global Resident Competency Rating Form on every resident after each rotation. Three specific professionalism questions from the Graduate Medical Education Global Resident Competency Rating Form were chosen as representations of standard professional behaviors. These questions were used to assess the change in resident professional behavior. RESULTS: Pre-intervention and post-intervention scores were compared. Mean post-intervention scores were higher by 0.4 to 0.5 points for each of the 3 questions (each p <0.01). There was less variation in scores after the intervention, suggesting that 1) residents were more consistent in their professional behavior and/or 2) the faculty observation of resident professional behaviors was more focused. CONCLUSIONS: These results suggest that training faculty and residents in professionalism may have a significant positive influence on improving resident professional behavior as well as the faculty ability to more objectively evaluate resident professional behaviors based on defined standards.     

A surgical skills elective can improve student confidence prior to internship

BACKGROUND: A focused surgical resident readiness curriculum for senior medical students can improve confidence in surgical skills compared to current surgical interns. MATERIALS AND METHODS: A 3-week surgical skills lab elective enrolled senior medical students applying to surgical residency programs, with the purpose of improving surgical skills and easing anxiety prior to surgical internship. Students were surveyed before and after the elective regarding their confidence in performing 21 skills covered by the curriculum. A similar confidence survey was administered to the incoming surgical intern class. Interns were also surveyed regarding prior skills lab instruction during medical school. Statistical analyses included Student's paired t-test and two-way analysis of variance. RESULTS: Six medical students and 23 interns were surveyed. All medical students significantly improved their confidence by the end of the resident readiness curriculum (P = 0.0004). Although students initially had lower confidence than surgical interns in performing surgical skills and in their knowledge of anatomy prior to the course, their confidence after the course was significantly higher than that of the incoming surgical interns (P = 0.035). Surgical interns with prior skills lab experience in their medical school reported higher confidence than those who did not have a skills lab experience (P = 0.019). Among all subgroups, medical students with skills lab experience had the highest confidence score, followed by interns with previous skills lab experience, then by interns with no previous skills lab experience, and last, by medical student with no skills lab experience. CONCLUSION: Surgical interns often feel unprepared to perform skills necessary for residency. A focused skills lab elective during medical school can bridge the gap and improve confidence prior to internship.     

Urology at your fingertips: the development of a urology m-learning app for medical students

BackgroundSurgical education has embraced advancing technology with an emphasis on e-learning in recent years. Smartphones are a useful tool for medical teaching and learning with increasing use by medical students to access e-books, medical calculators, podcasts, and medical applications (apps). Our aim was to develop a dedicated urology app for medical students as an adjunct to traditional teaching.MethodsWe published an e-book: Urology Handbook for Medical Students in 2017 based on the core urology curriculum for medical students. Subsequently, we developed a concise, simple and user-friendly smartphone app for medical students called “Urology Med”, available for download on App Store and Google Play.ResultsThis app is an introduction to urology for medical students but may also be useful for interns and surgical trainees. The app encompasses core urology topics subdivided into common urological presentations, urological examination, urological diseases, and urological devices. To make the app interactive, it includes 5 clinical cases that complement the reading material and six quizzes for self-assessment. A comprehensive checklist of 31 “must see” and “good to see” urology experiences is included. Within one month of launch, the app was downloaded 435 times in five countries across three continents. It has a 5-star rating on the Apple store.ConclusionsHigh educational standards with relevant content make e-learning a valuable learning tool for surgical education. The Urology Med app facilitates easy access to urology and is ideal for quick reading while working or revising.     

Determinants of medical student attitudes to a learning communication skills teaching program

BackgroundThe determinants of medical students’ attitudes to communication skills training have for long been a concern among medical educationalists. The present study was undertaken to assess the attitudes of undergraduate medical students towards the teaching of learning communication skills courses and their determinants.MethodsA total of 472 undergraduate medical students from the Universiti Sains Malaysia participated in this study. Students’ attitudes were measured using a modified communication skills attitude scale (CSAS). Univariate and multivariate statistics were applied to find the correlates to students’ attitudes.ResultsMore than 95% of the students desired to learn communication skills. The majority of the students preferred formal courses on communication skills during their clinical training years. Demographic characteristics, e.g. gender and place of family residence, and education-related characteristics such as a preference for a formal communication skills training program during clinical years, and perception of a curriculum content overload were identified as the important determinants of students’ attitudes towards learning communication skills.ConclusionsThe demographic and education-related profiles of the participating medical students should be considered when designing a communication skills teaching program. Further studies are recommended to explore the underlying causes of less interest from rural students and the negative attitudes of male students towards learning communication skills.     

Intensive care medicine trainees' perception of professionalism: a qualitative study

The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows' views on professionalism is available. A nationwide qualitative study was performed. The moderator asked participants to clarify the terms professionalism and professional behaviour, and to explore the questions "How do you learn the mentioned aspects?" and "What ways of learning do you find useful or superfluous?". Qualitative data analysis software (MAXQDA2007) facilitated analysis using an inductive coding approach. Thirty-five fellows across eight groups participated. The themes most frequently addressed were communication, keeping distance and boundaries, medical knowledge and expertise, respect, teamwork, leadership and organisation and management. Medical knowledge, expertise and technical skills seem to become more tacit when training progresses. Topics can be categorised into themes of workplace-based learning, by gathering practical experience, by following examples and receiving feedback on action, including learning from own and others' mistakes. Formal teaching courses (e.g. communication) and scheduled sessions addressing professionalism aspects were also valued. The emerging themes considered most relevant for intensivists were adequate communication skills and keeping boundaries with patients and relatives. Professionalism is mainly learned 'on the job' from role models in the intensive care unit. Formal teaching courses and sessions addressing professionalism aspects were nevertheless valued, and learning from own and others' mistakes was considered especially useful. Self-reflection as a starting point for learning professionalism was stressed.     

Surgical intern survival skills curriculum as an intern: does it help?

Background

The transition from medical student to surgical intern is fraught with anxiety. We implemented a surgical intern survival skills curriculum to alleviate this through a series of lectures and interactive sessions. The purpose of this pilot study was to evaluate its effectiveness.

Methods

This was a prospective observational pilot study of our surgical intern survival skills curriculum, the components of which included professionalism, medical documentation, pharmacy highlights, radiographic interpretations, nutrition, and mock clinical pages. The participants completed pre-course and post-course surveys to assess their confidence levels in the elements addressed using a 5-point Likert scale (1 = unsatisfactory, 5 = excellent). A P value of less than .05 was considered significant.

Results

In 2009, 8 interns participated in the surgical intern survival skills curriculum. Fifty percent were female and their mean age was 27.5 ± 1.5 years. Of 33 elements assessed, interns rated themselves as more confident in 27 upon completion of the course.

Conclusions

The implementation of a surgical intern survival skills curriculum significantly improved the confidence levels of general surgery interns and seemed to ease the transition from medical student to surgical intern.     

Assessing professionalism in surgeons

Professionalism has been identified as one of four domains of competency for surgical trainees in the UK. This implies that professionalism can be learned and assessed. The priorities of different professions and healthcare systems influence the value placed on different components of professionalism and UK surgeons need to identify the characteristics they would most value as part of an effective assessment process. The success of developing a taxonomy of non-technical skills for surgeons (NOTSS) can guide a similar process for a taxonomy for professionalism assessment. A multitude of assessment instruments for professionalism have been described in the literature but very few are valid, reliable or practical. For surgical trainees a number of assessment tools should be considered. A quantifiable tool using multi-source feedback could be the most practical for clinical surgeons to use. It is important, however, that it is not used to assess isolated behaviours but assess conduct within a surgical community of practice, and that the thinking process behind (un)professional behaviour is also understood, especially in stressful situations.     

Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients

ObjectiveTo evaluate the security and effectiveness of the TOT in the female incontinence surgical treatment according to our experience.Patient and MethodProspective study of 200 patients underwent TOT at Gynecology Unit of the Obstetrics and Gynecology Department in Barros Luco-Trudeau Hospital between January 2003 and October 2006. Polypropilene, macropore, mofilament mesh (Prolene) was used. The mean age was 52 years old, parity 3.ResultsThe mean surgical time of TOT was 15 minutes. In 184 (92%) patients obtained cure, 6 (3%) improvement and 10 (5%) fails. Three cases of bladder injury occurred (one perforation with the scissor and two with TOT needle during the learning phase). During the immediately postoperative time: one case of partial urethral obstruction, two cases of urinary infection and three with pain of the legs. During the delayed postoperative time a case of fail was observed after trauma.ConclusionAccording to our experience with 200 cases, the TOT appears as a safe and effective technique in the surgical treatment of the stress urinary incontinence.     

护理硕士专业学位研究生安全行为现状及影响因素分析

目的了解护理硕士专业学位研究生安全行为现状及影响因素,为提高其安全行为表现提供参考。方法便利选取48所高校的265名护理硕士专业学位研究生,采用一般资料调查表、安全行为量表、中文版实习护生患者安全态度和职业素养问卷、护理专业自我概念量表进行调查。结果护理硕士专业学位研究生安全行为总均分4.17±0.51、患者安全态度和职业素养总均分3.71±0.47,护理专业自我概念总均分2.83±0.35。患者安全态度和职业素养、护理专业自我概念与安全行为呈正相关(均P<0.01)。年级、患者安全态度和职业素养、护理专业自我概念是护理硕士专业学位研究生安全行为的影响因素(P<0.05,P<0.01),可解释其总变异的35.5%。结论护理硕士专业学位研究生安全行为表现较好,但有待进一步提高。护理教育者应特别重视低年级研究生的安全行为表现,采取针对性教育策略培养和提升其安全行为。     

Plastic surgery in the Norwegian undergraduate medical curriculum: students’ knowledge and attitudes. A nationwide case-control study

Objective: Changes in medical education have resulted in less available time for plastic surgery, which might jeopardise the availability of plastic surgery for patients. The aims of this study were to investigate the level of knowledge within and attitudes towards plastic surgery among medical students, and find predictors for a wish to pursue a career in plastic surgery.

Methods: A previously used questionnaire was sent to all clinical medical students. Law students were used as a control group.

Results: Thirty per cent of all clinical medical students in the country responded. The majority of students considered education in plastic surgery valuable/very valuable and 23% were considering it as a career. Nonetheless, about half of the students were unaware of the plastic surgical education at their faculty and reported non-academic sources of learning. Only 44% of medical students were able to name five common plastic surgical procedures and 8% were unable to name any. Law students were superior to medical students in the task (p?=?0.005). Forty-two per cent of medical students were successful in indicating on which body parts plastic surgeons operate, whereas law students were less successful (p?=?0.001). Male gender and positive valuing of clinical attachment could predict a wish for a career in plastic surgery.

Conclusion: In some aspects, medical students are only as knowledgeable as their non-medical peers. These results call for higher quality plastic surgery teaching, to secure referral of the correct patients and successful specialist recruitment to plastic surgery.     

Competency-based professionalism in anesthesiology: Continuing Professional Development

Purpose

Fulfilling the current societal expectations for professionalism in medicine requires a clear understanding of the specific skills, attitudes, and behaviours expected of practitioners. This Continuing Professional Development (CPD) module discusses professionalism as it relates to the practice of anesthesiology.

Principal findings

While many of the attributes of the professional are generic, performance expectations must be interpreted in a specialty-specific context. Anesthesiologists face challenges to their professionalism in the time-constrained, highly technical and stressful operating room environment. Ongoing shifts in the models of health care delivery require the adaptation of anesthesiology practice to meet changing demands. Consequently, anesthesiologists?? practice environment has extended into preoperative assessment units, acute pain services, and perioperative medicine. Application of principles of biomedical ethics, understanding of medico-legal and regulatory aspects of practice, and attention to personal health and career sustainability are intrinsic aspects of professional practice. More recently, focus on adverse event management and continuous quality improvement has created the need for specific skill sets, which must be included in training and continuing professional development programs. The medical education literature suggests teaching and evaluation methods suited to the development of competence in all aspects of professionalism. Finally, professionalism requires the availability of remediation programs for learners and practitioners in difficulty.

Conclusion

The attitudes, skills, and behaviours that define professionalism in anesthesiology must be taught and evaluated to establish a basic level of competence by the completion of specialty training. Throughout their careers, anesthesiologists must continue their professional development to meet current and future societal expectations and shifting norms of health care delivery.     

Professionalism in anesthesia

Purpose

Is professionalism in medicine just another bureaucratic imposition on our practice or a fundamental concept for physicians at all stages in their career? In this review, the historical perspectives of professionalism are explored as well as the what, why, and how questions concerning this topic.

Source

The key words “professionalism” and “anesthesia” were used to conduct a search of the PubMed database, the policies and publications of relevant Canadian and international physician regulatory bodies and organizations, historical documents, and other internet publications.

Principal findings

Professionalism in anesthesia has a long history. While there are many definitions for professionalism, some very dated, all are based on virtues, behaviour, or professional identity. Professionalism plays a central role in the balance between physician autonomy and social contract, and it has a significant impact on patient safety and medicolegal litigation.

Conclusion

Considerable evidence exists to suggest that professionalism must be treated seriously, particularly in these times of social accountability and budgetary pressures.

     

Surgical interns in 2018: Objective assessment suggests they are better but still lack critical knowledge and skill

BackgroundThe transition from fourth-year medical student to surgical intern is difficult. A lack of repetitions, experience, and knowledge is problematic. We report our experience using simulation-based technical and nontechnical skills to assess the competency of surgical interns in July and January of their intern year.DesignAs part of a larger assessment effort, our general surgery interns (2010–2016) have been tested on performing an emergent cricothyrotomy, interpreting 2 arterial blood gases, and reading 3 chest x-rays in fewer than 7 minutes. We retrospectively analyzed general surgery interns’ performance on these 3 tests (total score = 20).ResultsA total of 210 interns completed both July and January (identical) assessments. Overall mean scores improved from July (12.62 ± 3.44) to January (16.5 ± 2.46; P < .05). During the study period general surgery interns’ mean baseline scores improved in both July (P < .05) and in January (P < .05). Although most individual general surgery interns did improve their total scores (92% improved, 3% same, 5% worse) between July and January (P < .05), in January 40% could not perform an emergent cricothyrotomy swiftly, and 6% missed a tension pneumothorax on chest x-ray.ConclusionOur data suggest that surgical interns start residency training with low levels of skill and comprehension with emergent cricothyrotomy, arterial blood gas, and chest x-ray. They improve with 6 months of clinical and simulation training. Encouragingly, overall scores for both July and January assessments have improved during the study period. Given that some interns still struggle in January to perform these three tasks, we believe that 2018 interns are better, but still potentially lack critical knowledge and skill.     

Engaging medical students in the feedback process

BackgroundThere are potential advantages to engaging medical students in the feedback process, but efforts to do so have yielded mixed results. The purpose of this study was to evaluate a student-focused feedback instructional session in an experimental setting.MethodsMedical students were assigned randomly to either the intervention or control groups and then assigned randomly to receive either feedback or compliments. Tests of knowledge, skills, and attitudes were given before and after the intervention.ResultsThere was a significant gain of knowledge and skill in the group that received instruction. Satisfaction was higher after compliments in the control group but higher after feedback in the instructional group. There was no change in the subject's willingness to seek feedback.ConclusionsA student-focused component should be carefully included as part of an overall effort to improve feedback in surgical education. The role of medical student attitudes about feedback requires further investigation.     

Surgery service learning in preclinical years improves medical student attitudes toward surgery,clinical confidence,and social determinants of health screening

IntroductionPatient health literacy is paramount for optimal outcomes. The Service Learning Project (SLP) aims to merge the need for patient education with the desire of medical students for early clinical experience.MethodsThis pretest-posttest study examined the effect of the SLP on medical students. First-year students spent 8 h each month educating inpatients and screening for social determinants of health (SDH). Students completed a 30-question survey pre- and post-SLP, and longitudinally throughout medical school. We used t-tests to assess changes in attitudes towards surgery, clinical confidence, and SDH screening.ResultsStudent self-perceived value on surgical teams increased significantly (2.49 vs 3.63 post-SLP, p < 0.001), as did their confidence interacting with patients (3.66–4.14, p = 0.002) and confidence assessing for SDH (3.13–4.75, p = 0.002). 100% of students continued to assess for SDH on clerkships.ConclusionsThe SLP model improves medical students’ skills and confidence working with patients and addressing SDH.