Ms Liz Anderson

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Ms Liz Anderson Dr Hayley Richards

• Changing our approach to assessing professional
  behaviour

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Aims

• Background why is assessing Professional
  Behaviour an issue?
• The University of Bristol approach to assessment
• Case study example

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Different discourses in medical education through
the ages

• different definitions of in competence ??

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Fitness to Practice?

• Societies expectations of what doctors are and
  what they changes and a contemporary discourse
  makes doctors accountable to the public in full
  view of the media spotlight

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Doctors and Society

• Until quite recently, the role of doctors in
  peoples lives. were well understood. That is no
  longer the case. Social and political factors,
  together with the achievement and promise of
  medical science, have reshaped attitudes and
  expectations of both public and doctors.
• Royal College of Physicians 2005

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Good Medical Practice

• Patients must be able to trust doctors with their
  lives and well-being. To justify that trust, we
  as a profession have a duty to maintain a good
  standard of practice and care and to show respect
  for human life.
• GMC May 2001

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Promoting Professional Development

• Explicit values/attitudes/behaviours that are
  repeatedly demonstrated in the learning
  environment
• Curriculum should incorporate model of emotional
  as well as cognitive development
• Mentorship should be encouraged
• Reflective styles of teaching learning promoted
• Howe, A. Medical Education 2002
• Hilton Slotnick, Medical Education 2005

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Assessing Professional Behaviour

• Little evidence for predictors at admission
• Evaluation of attitudes and behaviours, like
  conscientiousness, good timekeeping, good record
  keeping, appear to be predictors
• Self assessment relatively inaccurate
• Stern et al, Medical Education 2005
• Poorly performing doctors more likely to have
  exhibited attitudinal problems at medical school
• Papadakis et al 2004

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Bristol Approach

• Professional behaviour assessed on three
  dimensions
• Appearance
• Attendance punctuality
• Attitude behaviour

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Students who fail professional behaviour

• sub-standard professional behaviour results in a
  review of clinical knowledge

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The Remedial Placement Assessment methods

• Reflection
• Formative assessment
• Formative feedback
• Peer assessment
• Personal goal setting
• Direct observation

• Self-assessment
• Discussion
• Self-directed enquiry
• Role modelling

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The Remedial Placement The Students

• disorganised casualness or an inability to grasp
  the significance of her behaviour.
• in spite of his clear intellectual ability, he
  hasnt been able to perform at an acceptable
  level.

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Reflection

• discuss professional issues in a safe
  environment, personalize them and, it is hoped,
  internalize them over the course of education and
  training Maudsley Strivens 2003
• The insight gained becomes part of a larger body
  of knowledge described as tacit that which one
  knows but cannot tell Polyani 1958
• Development of professional identity

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Formative Assessment and Feedback
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Formative Feedback
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Formative Assessment and Feedback

• For feedback to be successful,
• The student must possess a concept of the
  standard (or goal) being aimed for Sadler 1989
• The teacher must share the same concept of the
  goal Hounsell 1997

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Formative Feedback Constructivist model
From Juwah et al 2004 Enhancing Student Learning
through Effective Formative Feedback
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Peer Assessment

• Correlate with faculty opinion
• Stable over time
• Halo effect
• Individual level
• Near-peer assessment
• Multi-disciplinary

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Student comments

• All students should have the opportunity to do
  this
• Memorising is not always the best way to learn
• I never thought much about what it really means
  to be a doctor

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Summary

• Prioritize the teaching assessment of
  professional behaviour from Year 1 upwards.
• Reflection formative feedback are powerful
  tools, but teachers may need more guidance.
• Desired behaviours must be made explicit.