The performance of doctors: the new professionalism
About: This article is published in The Lancet.The article was published on 1999-04-03. It has received 148 citations till now. The article focuses on the topics: Health care & Public health.
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TL;DR: The role model framework is of use in the assessment of the needs for staff to implement a curriculum, in the appointment and promotion of teachers and in the organization of a staff development programme.
Abstract: Teaching is a demanding and complex task. This guide looks at teaching and what it involves. Implicit in the widely accepted and far-reaching changes in medical education is a changing role for the medical teacher. Twelve roles have been identified and these can be grouped in six areas in the model presented: (1) the information provider in the lecture, and in the clinical context; (2) the role model on-the-job, and in more formal teaching settings; (3) the facilitator as a mentor and learning facilitator; (4) the student assessor and curriculum evaluator; (5) the curriculum and course planner; and (6) the resource material creator, and study guide producer. As presented in the model, some roles require more medical expertise and others more educational expertise. Some roles have more direct face-to-face contact with students and others less. The roles are presented in a 'competing values' framework-they may convey conflicting messages, e.g. providing information or encouraging independent learning, helpi...
826 citations
TL;DR: A circumscribed concept of professionalism is available to serve as a foundation for next steps in assessing professional behavior and future research should explore rigorous qualitative techniques; refine quantitative assessments of competence; and evaluate separate elements of professionalism.
Abstract: PurposeThe author interprets the state of the art of assessing professional behavior. She defines the concept of professionalism, reviews the psychometric properties of key approaches to assessing professionalism, conveys major findings that these approaches produced, and discusses recommend
479 citations
TL;DR: Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity.
Abstract: Review date: Review period January 1992–December 2001. Final analysis July 2004–January 2005.Background and review context: There has been no rigorous systematic review of the outcomes of early exp...
426 citations
Cites background from "The performance of doctors: the new..."
...Most fall under the broad heading of ‘professionalism’ (Irvine, 1999; Medical Professionalism Project, 2002): developing appropriate attitudes towards oneself, towards other people, and towards one’s studies; being able to communicate well and see other people’s points of view; and socializing to…...
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TL;DR: This paper provides a framework based on the three-circle model: what the doctor should be able to do, the approaches to doing it ('doing the thing right') and the development of the individual as a professional ('the right person doing it').
Abstract: Increased attention is being paid to the specification of learning outcomes.This paper provides a framework based on the three-circle model: what the doctor should be able to do ('doing the right thing'), the approaches to doing it ('doing the thing right') and the development of the individual as a professional ('the right person doing it').Twelve learning outcomes are specified, and these are further subdivided.The different outcomes have been defined at an appropriate level of generality to allow adaptability to the phases of the curriculum, to the subject matter, to the instructional methodology and to the students' learning needs. Outcomes in each of the three areas have distinct underlying characteristics.They move from technical competences or intelligences to meta-competences including academic, emotional, analytical, creative and personal intelligences. The Dundee outcome model offers an intuitive, user-friendly and transparent approach to communicating learning outcomes. It encourages a holistic and integrated approach to medical education and helps to avoid tension between vocational and academic perspectives.The framework can be easily adapted to local needs. It emphasizes the relevance and validity of outcomes to medical practice.The model is relevant to all phases of education and can facilitate the continuum between the different phases. It has the potential of facilitating a comparison between different training programmes in medicine and between different professions engaged in health care delivery.
374 citations
TL;DR: The nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors‐in‐training is considered.
Abstract: INTRODUCTION: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training. THESIS AND DISCUSSION: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis, or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement. CONCLUSION: Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.
352 citations
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TL;DR: The Bristol case will probably prove much more important to the future of health care in Britain than the reforms suggested in the white papers, and its most profound effect may well be on the relationship between individual doctors and patients.
Abstract: News p 1924 Letters p 1986
“The Bristol case,” in which judgment was passed last week1 will probably prove much more important to the future of health care in Britain than the reforms suggested in the white papers. Reorganisations of the NHS come round with monotonous regularity, but changes on the wards and in surgeries are slow and often unrelated to the passing political rhetoric. 2 3 In contrast, the Bristol case is a once in a lifetime drama that has held the attention of doctors and patients in a way that a white paper can never hope to match. The case has thrown up a long list of important issues (see box) that British medicine will take years to address. At the heart of the tragedy, which has been Shakespearean in its scale and structure, is, as the GMC said, “the trust that patients place in their doctors.” That trust will never be the same again, but that will be a good thing if we move to an active rather than a passive trust, where doctors share uncertainty.
The trust between doctors and patients works on two main levels: between individual patients and doctors and between society and doctors' organisations. The Bristol case will affect both. The most profound—but least easily measured—effect may well be on the relationship between individual doctors and patients. In the past two weeks the case must have been in the minds of many patients consulting doctors, particularly those about to undergo operations. Worldwide, the doctor-patient relationship is changing.4-6 For instance, the main theme of last week's world conference of general practitioners in Dublin …
309 citations
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01 Jan 1911
TL;DR: The Project Gutenberg EBook of The Doctor's Dilemma, by George Bernard Shaw #30 in our series as mentioned in this paper, is the first book to be published in this series.
Abstract: The Project Gutenberg EBook of The Doctor's Dilemma, by George Bernard Shaw #30 in our series by George Bernard Shaw Copyright laws are changing all over the world. Be sure to check the copyright laws for your country before downloading or redistributing this or any other Project Gutenberg eBook. This header should be the first thing seen when viewing this Project Gutenberg file. Please do not remove it. Do not change or edit the header without written permission. Please read the "legal small print," and other information about the eBook and Project Gutenberg at the bottom of this file. Included is important information about your specific rights and restrictions in how the file may be used. You can also find out about how to make a donation to Project Gutenberg, and how to get involved.
178 citations
TL;DR: A modern expression of medical professionalism, founded on sound self regulation, that should bring the public's and the profession's interests together successfully is proposed.
Abstract: The performance of doctors embraces attitudes to practice, knowledge, and skills. It is the outward and visible expression of our professionalism. In general, people think highly of the medical profession in Britain; rising expectations are a mark of our success. Nevertheless, self regulation, on which our professional independence and self respect depend, cannot be taken for granted. Sympathetic critics such as lay people, sociologists, and doctors reflect a wider public perception that we seem reluctant to assure doctors' competence and protect patients from poor practice. There are also criticisms that we are not addressing the widespread dissatisfaction with the attitude of some doctors, including their paternalism and poor communication with both patients and colleagues, and are failing to make self regulation demonstrably effective and responsive.1 2 3 4 5 6 7 8 9 10 11 12
These criticisms, if not dealt with, could seriously damage public trust. They provide ammunition for people who oppose professional self regulation on the grounds that, where doctors' and patients' interests conflict, doctors' interests will invariably come first. Greater external control of the profession is their prescription.
In this article, and another to follow, I propose a modern expression of medical professionalism, founded on sound self regulation, that should bring the public's and the profession's interests together successfully.
Our professionalism is shaped by the context in which we work. First and foremost, medical knowledge and skill have expanded at an unprecedented rate. This, together with the revolution in information technology, has huge implications for the profession. Can we, for example, maintain medicine as a distinctive entity in the face of growing subspecialisation? Can we adapt to careers that may not last a lifetime without reorientation and retraining?
People know more about health matters because they have independent access to clinical information and because their …
162 citations
Book•
01 Jan 1995
TL;DR: The issues - why they are important making mistakes - how doctors think about friendly efforts - the informal mechanisms frustration mounts - requiring "the skill of a politician and the tact of a diplomat" behind closed doors.
Abstract: The issues - why they are important making mistakes - how doctors think about this friendly efforts - the informal mechanisms frustration mounts - requiring "the skill of a politician and the tact of a diplomat" behind closed doors - how effective are the informal mechanisms? empirical research on medical mishaps and mistakes - challenges to professional norms coming changes - will they make a difference?
93 citations