The YouTube generation: implications for medical professionalism

While medical education has remained relatively constant over the past century, the rising popularity of internet-based technologies, such as applications for social networking, media sharing, or blogging, has drastically changed the way in which physicians-in-training interact with educators, peers, and the outside world. The implementation of these new technologies creates new challenges and opportunities for medical educators. Representation, the absence of established policies and legal precedents, and the perception of the lay public exemplify some of the issues that arise when considering the digital images used by trainees. While some of these issues affect higher education generally, medical schools are faced with additional challenges to ensure that graduates exemplify the ideals of medical professionalism. We present a case vignette with subsequent discussion to highlight the complexities of ensuring medical professionalism in the digital age.     

Teaching professionalism: a tale of three schools

This article compares professionalism education from the vantage points of three different disciplines: medicine, law, and business. In particular, it asks how each of these professions conceives of "professionalism," and how these different conceptions affect what is taught to graduate students. The object of professionalism education differs among these three disciplines, as do the specific challenges to professionalism and professionalism education. The article offers examples of how professionalism is taught in medicine, law, and business, and what each profession might learn from the others in developing their professionalism education and pedagogy.     

Physicianship: Educating for professionalism in the post-Flexnarian era

Although he did not write extensively about professionalism, Abraham Flexner clearly understood its critical role in medical practice. In discerning the basics of medical education he characterized scientific methodology as the instrumental minimum. He left open to future generations the task of defining its necessary complement, the "noble behaviors and fine feelings" required of the medical practitioner. Situated within the current professionalism movement, and informed by previous commentary on the enduring attributes of medicine, a curriculum based on "Physicianship"--the physician as healer and professional--can serve as a logical post-Flexnerian curriculum. The conceptual armature of Physicianship and the attributes necessary for the fulfillment of both the professional and healer role can assist in the selection of students and constitute the educational blueprint for medical teaching. The critically important concepts of identity formation and the requirements for the valid and reliable assessment of professional behaviors of students and faculty are essential components. A Physicianship curriculum, as conceived and deployed at the McGill University Faculty of Medicine, might resonate with Flexner.     

Medical professionalism and the doctor-patient relationship

The practice of medicine increasingly poses obstacles to the cultivation of strong relationships between physicians and their patients. The current discussion of medical professionalism aims to identify some of these obstacles and to improve both the doctor-patient relationship and the quality of medical care. In this essay, we explore professionalism within the context of the relationship between physician and patient and examine the concrete actions, behaviors, and qualities that medical professionalism requires of physicians in today's challenging environment.     

Regulation of financial conflicts of interest in medical practice and medical research: a damaging solution in search of a problem

The free market, which includes most practicing physicians, publicly supported biomedical researchers, and private drug and device companies, has succeeded spectacularly in delivering new medical technologies to the public. Increased interactions between doctors (physicians and biomedical researchers), epitomized by the founding of the biotechnology revolution, have and can continue to accelerate this delivery. A powerful anti-commercial advocacy movement that has blossomed over the past 20 years threatens this momentum. This movement has succeeded in inverting reality by demonizing the market and by promoting distorted and damaging views of professionalism and of science. Most ominously, it has imposed onerous and counterproductive regulations on medical education and translational research.     

Medical professionalism videos on YouTube: Content exploration and appraisal of user engagement

BackgroundSocial media has become the fastest growing platform for sharing and retrieving information and knowledge, and YouTube is one of the most popular and growing sources of health and educational information video-sharing website. But, videos on this open platform are not peer-assessed, therefore, the accessible data should be adequately assessed. Till date, no exploration and analysis for assessing the credibility and usefulness of Medical professionalism videos available on YouTube are conducted.ObjectiveTo analyze the video sources, contents and quality of YouTube videos about the topic of medical professionalism.MethodsA systematic search was accomplished on YouTube videos during the period between March 1, 2020 and March 27, 2020. The phrases as significant words used throughout YouTube web search were ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, ‘Attributes of professionalism’. The basic information collected for each video included author’s/publisher’s name, total number of watchers, likes, dislikes and positive and undesirable remarks. The videos were categorized into educationally useful and useless established on the content, correctness of the knowledge and the advices. Different variables were measured and correlated for the data analysis.YouTube website was searched the using keywords ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, and ‘Attributes of professionalism’.ResultsAfter 2 rounds of screening by the subject experts and critical analysis of all the 137 YouTube videos, only 41 (29.92%) were identified as pertinent to the subject matter, i.e., educational type. After on expert viewing these 41 videos established upon our pre-set inclusion/exclusion criteria, only 17 (41.46%) videos were found to be academically valuable in nature.ConclusionMedical professionalism multimedia videos uploaded by the healthcare specialists or organizations on YouTube provided reliable information for medical students, healthcare workers and other professional. We conclude that YouTube is a leading and free online source of videos meant for students or other healthcare workers yet the viewers need to be aware of the source prior to using it for training learning.     

医学生科研创新能力培养“3+X”模式的探索与实践

针对长期以来培养医学生的科研创新能力主要依靠零散的课外科研活动、受众面窄、没有系统性课程教学及其相关制度保障、致使对医学生科研创新能力培养明显乏力低效这一共性瓶颈教学问题,自2002年起,汕头大学医学院生物化学与分子生物学教学团队,在“科教相辅相佐”、“以学生为中心”、“以问题为导向”等先进教育理念指导下,倚重汕头大学医学院“医者之心”系列课程与书院育人文化之特色,发挥汕头大学的生物学、基础医学和临床医学一级学科均拥有本/硕/博/博后完整人才培养体系之优势,联合其他相关专业教学团队,在建立充分体现医学生科研创新能力培养内涵,覆盖医学本科5年全过程的核心课程体系的基础之上,历经20载的不懈努力,补充修善,成功构建了“3+X”模式,着力培养医学生的科研创新能力。所谓“3”意指对医学生的“全人培养”、“全程培养”和“全方位培养”。所谓“X”意指针对“3+X”模式运行效能的若干个验证性维度,主要包括组织医学生参加各种形式的全国大学生创新实验研究大赛、国际大学生学术研讨会,由医学本科生作为第一作者撰写发表学术论文等。培养医学生科研创新能力的成效十分显著,为有效解决上述共性瓶颈教学问题提供了一个有重要借鉴价值的范例。     

Beyond the physician charter: reflections on medical professionalism

The numerous challenges now facing the profession of medicine have led to an intense focus on professionalism by individual physicians and by their professional and academic organizations. In 2002, a distinguished group of leaders in internal medicine created the Physician Charter, which calls on physicians to reaffirm medical professionalism through commitment to three principles and 10 responsibilities. The Charter reflects a duty-based ethic that is chiefly concerned with physician competence. This article offers a critical analysis of the Physician Charter from the perspective of the traditional values of medicine as articulated in medical oaths and championed by leaders of past generations, exemplified by William Osler. The authors argue that medical professionalism should reflect the values of a virtue-based ethic that stresses compassion and beneficence, rather than the values of a duty-based ethic. The challenges that now confront the practice of medicine can be addressed successfully only to the extent that physicians promote virtue-ethics, act collectively in the public interest, and render service that clearly transcends their own self-interests.     

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

Background

Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals.

Objective

To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors.

Methods and Materials

We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives.

Results

In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors.

Conclusion

A tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality.     

Survey on Ethical Conduct Thresholds in Cardiologal Medical Practice in Argentina

The purpose of this study was to analyze the attitude of a group of cardiologists on the ethical conducts they would accept or adopt when encountered with different hypothetical situations of medical practice. Between August and September of 2011, 700 Argentine cardiologists were surveyed in situations which posed ethical dilemmas in the patient‐physician relationship, among colleagues or involving financial agreements with employers or the pharmaceutical industry. Ethical conflicts were evidenced in a series of inappropriate conducts such as differential fees, trips and meals sponsored by laboratories, splitting fees, overbilling, self‐referral, charging for patient referral, financial compensation for ordering medical procedures, and various situations derived from the relationship with employers. In general, financial compensation from the pharmaceutical industry was more accepted than the conflictive situations which directly involved patients, colleagues or employers. The rejection of these conducts, the physicians' deontological education and the improvement of financial and organizational conditions in medical practice will help to encourage better medical professionalism and avoid unseemly behaviors.     

Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years

Background

Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning.

Methods

We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education.

Results

In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3^rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2^nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum.

Interpretation

Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.     

Moving beyond nostalgia and motives: towards a complexity science view of medical professionalism

Modern-day discourse on medical professionalism has largely been dominated by a "nostalgic" view, emphasizing individual motives and behaviors. Shaped by a defining conflict between commercialism and professionalism, this discourse has unfolded through a series of waves, the first four of which are discovery, definition, assessment, and institutionalization. They have unfolded in a series of highly interactive and overlapping sequences that extend into the present. The fifth wave-linking structure and agency-which is nascent, proposes to shift our focus on professionalism from changing individuals to modifying the underlying structural and environmental forces that shape social actors and actions. The sixth wave-complexity science-is more incubatory in nature and seeks to recast social actors, social structures, and environmental factors as interactive, adaptive, and interdependent. Moving towards such a framing is necessary if medicine is to effectively reestablish professionalism as a core principle.     

Medical professionalism: one size fits all?

A number of medical specialties have recently developed their own specialty-specific charters. This proliferation of charters is representative of an unease about medical professionalism that has arisen not just from increasing medical specialization, but also from evolving needs as physicians progress through their careers. The development of such specialty-specific definitions of professionalism is undesirable: all specialties should adhere to the same basic principles. These charters and "definitions" should be incorporated into a formal developmental model, derived from needs assessments from the level of medical school through the level of specialization. Such a model would provide physicians with more concrete guidance regarding professional behavior at each stage of their careers, address unmet needs in neglected areas such as mid- and late career, and help alleviate the tension associated with expressing these ideas. Incorporating concepts derived from more classic models of development may create opportunities to address the teaching of values and identify barriers to success.     

"Post-residency disease" and the medical self: identity, work, and health care among doctors who become patients

Doctors who become patients due to serious illnesses face many challenges related to issues of identity, work, and professionalism. In-depth interviews with such doctors reveal the complex ways in which illness threatens identity in these professionals. In comparison with "medical student's disease," these doctors now exhibit "post-residency disease"-minimizing physical symptoms that are in fact present, leading to decreases in care sought. Doctors often feel they are somehow invulnerable to disease and have to remain strong, not burdening others. Many describe themselves as "workaholics," which can prove to be a double-edged sword, posing problems as well as providing benefits. This professional commitment could interfere with preventive health behaviors and with "practicing what they preach." Some view their illness with their "medical self" - as if they were a physician observing another patient rather than themselves. These doctors often support their approach by choosing a colleague as a doctor who will not challenge them, thereby establishing a "denial system" as opposed to a support system. These doctor-patients confront difficult issues of how much their physicianhood is an identity or an activity, illustrating the intricate relationships and tensions between work, identity, professionalism, and health in contemporary medicine.     

Medical professionalism: crossing a generational divide

A comprehensive discussion of professionalism in medicine must include its impact on successive generations of physicians. Fifty years ago, doctors acting professionally emphasized medicine as a calling and an ability to act as the authority for patients in crisis at home and in hospitals. Therapeutic options were limited relative to the modern era, and the laying on of hands was practiced as science and art. Today, doctors balance increasing demands on time and efficiency with the sense of primacy of patient care. Technological innovation and patients' increasing access to medical knowledge through varying media of inconsistent quality challenge physicians in novel ways. Fifty years in the future, doctors will have access to vast amounts of information through a multitude of noninvasive diagnostics. Progressively more personalized medicine should inspire doctors to become even more adept at communicating effectively with patients. Professionalism in medicine throughout these generations embodies similar fundamental behaviors, such as demonstrating compassion, respect, and humility; adhering to high ethical and moral standards; subordinating personal interest to that of others; and reflecting on actions and decisions. Despite the dynamic nature of the profession itself, the omnipresent need for such traits will define medical professionalism for decades to come.     

Expectations and obligations: professionalism and medicine's social contract with society

As health care has become of great importance to both individual citizens and to society, it has become more important to understand medicine's relationship to the society it serves in order to have a basis for meaningful dialogue. During the past decade, individuals in the medical, legal, social sciences, and health policy fields have suggested that professionalism serves as the basis of medicine's relationship with society, and many have termed this relationship a social contract. However, the concept of medicine's social contract remains vague, and the implications of its existence have not been fully explored. This paper endorses the use of the term social contract, examines the origin of the concept and its relationship to professionalism, traces its evolution and application to medicine, describes the expectations of the various parties to the contract, and explores some of the implications of its use.     

“WE CAME TO TALK WITH THE PEOPLE BEHIND THE DISEASE:” COMMUNICATION AND CONTROL IN MEDICAL EDUCATION

To explore the ways in which biomedical culture responds to the new curricular addition of communication skills training, we observed activities related to the communication skills training of a class of 70 first-year medical students in an Israeli medical school during 2002–3. In addition, focus groups were conducted with medical students (n = 210) during 1998–2001. A gap was found between the rhetoric of “patient-centered communication” and “empathy” and the traditional concerns of medical authority, efficiency, and scientism. Communication skills and empathy training were appropriated into medical socialization by being reconstructed as clinical competence. Findings are further discussed in the context of medical professionalism, Israeli culture, service acting and service roles, and organizational learning.     

Medical professionalism and the social contract

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.     

On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians

We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of ‘patient’ and the role of ‘physician’. As a ‘physician’ the student operates the medical devices to clinically assess ‘patient’ colleagues and records all results in an electronic ‘patient’ record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated.The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students’ transition from preclinical to clinical subjects.