Professionalism and Revalidation

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Professionalism and Revalidation

• Day release 3/11/09

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Perspectives

• Professional men they have no cares whatever
  happens they get theirs
• 
  Ogden Nash
• All professions are conspiracies against the
  laity
• 
  George Bernard Shaw
• Pearly gates

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TASK!

• Professionalism what do you understand by it?
• List describe attributes or qualities
  which make up professionalism
• Come up with a definition of professionalism
• What do you think the public understands by
  professionalism?

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Professionalism-what is it?

• Medical professionalism signifies a set of
  values, behaviours, and relationships that
  underpins the trust the public has in doctors
• Medicine is a vocation in which a Drs knowledge,
  clinical skills, and judgement, are put in the
  service of protecting and restoring human
  well-being. This purpose is realised through a
  partnership between patient Dr, one based on
  mutual respect, individual responsibility,
  appropriate accountability
• 
  Royal College of Physicians 2005
• 
  

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• In their practice, Drs are committed to
• Integrity
• Compassion
• Altruism
• Continuous improvement
• Excellence
• Working in partnership with members of the wider
  healthcare team
• 
  RCP 2005

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Whats in a word?

• Professional
• Opposite of amateur-paid
• Military-ruthless efficiency
• Hitman-as above
• Sport-professional foul

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Hippocrates

• father of medicine
• Practised around 420BC
• Closed societies on island of Cos-medicine
  competed
• Oath contains elements of the Dr as an altruistic
  healer
• Also reinforces idea of the closed shop-mysteries
  of health only to be known by the privileged few

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North America

• Defines professionalism in education practice
• Since 1999 all specialist training has
  incorporated professionalism as a core competency

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NHS report by the National Clinical Assessment
Service 2009

• Professionalism is comprised of 6 domains
• Competency encompassing knowledge, skills
  ethics, their application in practice
• Personal relationships communication,
  teamworking
• Professional boundaries awareness, conflicting
  roles, friends
• Consistency reliability of practice mistakes
  (no. or judgement)
• Reflection learning for the Dr delegated
  tasks
• Commitment to service private behaviour,
  personal beliefs

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Ct

• In conclusion, professionalism is more than
  being competent must
• cover all domains as well as leadership
  integrity it should be embedded
• in policy, standards guidelines to ensure
  compliance. Managing
• perceived deficiencies in professionalism
  requires expertise, a
• structured, transparent process, paying proper
  regard to the rights of all
• involved, who themselves should receive the
  support they need
• 
  NCAS 2009

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Professionalism under threat

• Due to
• Incidents-Bristol, Shipman
• Expectations-public, government, new developments
• Demand-politics, population changes, innovations
• Managerial control-strategies, targets, budgets
• Teamworking-loss of control, appropriate
  delegation
• Legislation-working hours, equality diversity

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Licensure

• A regulative bargain whereby
• Society grants the profession autonomy in return
  for the profession guaranteeing standards of care
  and safety
• Because

There is such an unusual degree of knowledge of
skill that non professionals are not equipped to
evaluate or regulate Professionals are
responsible A profession will take regulatory
action in cases of incompetent or unethical
practice
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So.. What do we expect of professionals

• Good at their day to day job (performance)
• Able to deal with rarer and more unusual facets
  (keeping up to date)
• Someone we can trust (the right sort of person)
• An individual who acts on behalf of another in
  situations of complexity and uncertainty

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Can it be measured?

• Day to day work GPs diagnose and manage.
  (audit, SEA)
• Deal with rare but important knowledge test /
  CPD
• Can be trusted - views of patients / colleagues /
  complaints

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For what purpose?

• To attest those on the Specialty Register have
  the knowledge, skills and behaviours required of
  their discipline
• To encourage excellence / CQI
• To determine when targeted help is needed
• To build public confidence in the system

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Assessment of professionalism

• Students moral reasoning
• Not measurednot valued
• Context
• Include conflict
• Resolve dilemmas-rarely black white
• Formative/summative
• Multiple raters/triangulation clinical
  competence/communication skills/ethical legal
  understanding as foundation. Excellence/humanism/a
  ccountability/altruism as pillars. All leading to
  professionalism

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Darzi (NHS next stage review)

• Over regulation can damage morale
• Dismiss regulation as an organising principle
• Replace regulation with quality, as defined by
  clinical effectiveness, patient safety patient
  experience
• Devolve power to regions
• Use professionalism as a lever to raise standards
• Reduce professional boundaries
• Innovation research
• Leadership development to make the NHS work

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TASK

• Dilemmas/scenarios