Teaching Professionalism Requires Intentionality not Happenstance
by Rickeia Selmon, PharmD, MPH, PGY1 Pharmacy Practice Resident, Mississippi Department of Health Pharmacy Resident
A true teacher does not terrorize ignorant students.
A true teacher knows that it is his job to cure ignorance.1
Miriam Defensor-Santigo, Senator from the Republic of the Philippines
This quote resonates with me because it explains why professionalism must be embedded throughout health professions curricula … and taught with kindness. Health professionals should carry themselves in a manner that is expected by patients. When professionals demonstrate their professionalism, it produces trust in patients. Although patients may not trust the healthcare system, a health professional can earn a patient’s trust.2 A patient is not going to automatically trust you just because you are a physician, nurse, pharmacist, physical and occupational therapist, or dentist.
It is imperative to train the next generation of healthcare professionals to be effective communicators, dependable, team players, and respectful. The lack of professionalism can lead to serious consequences that impact patient care and safety by increasing the risk of “surgical site infections, readmissions, medical complications, psychological and financial harm to patients.”2 The goal of health professions education should be to couple high academic standards with a humanistic approach to care, resulting in the best health outcomes for our patients.
During my years in pharmacy school, I took pride in wearing professional attire, being dependable and timely, and communicating efficiently with instructors and employers. I prided myself on using appropriate email etiquette, and I admired other professionals who demonstrated my definition of professionalism.
Unfortunately, I also witnessed unprofessional behaviors that needed to be addressed. I saw student colleagues disrespect other students and professors, send emails to professors as if they were sending informal texts to friends, participate in health fairs wearing casual clothing, arrive late, or worse, fail to show up for a clinical experience without communicating with their preceptor/supervisor. Other than a few email communications and a course that explored some concepts related to professionalism during the first year of school, it wasn’t something woven throughout the curriculum. Many students decided what professionalism meant to them and how they would appear as professionals on their terms. In the era of COVID, virtual online classes became the norm, and when we were mandated to turn the camera on, I remember students bundled in bed comfortably under their blankets or cooking breakfast who were “participating” in class.
Broadly defined, professionalism is the “conduct, aims, or qualities that characterize or mark a profession.”3 Health care is delivered by teams of professionals who need to communicate well, respect the principles of honesty, excellence, confidentiality, and take responsibility for their actions. Unprofessional behavior can be triggered by chronic fatigue, burnout, a variety of societal and personal stressors, over-commitment, or poor physical health.2 Acknowledging these triggers may be beneficial when teaching students and explaining how these factors can adversely impact clinician behavior and patient care.
After completing a series of rigorous didactic courses and clinical experiences, it is assumed that students will simply exhibit professional behavior by happenstance. Professionalism should be intentionally taught and assessed. Assessments are a driver and motivate students to learn and abide by professional standards.4 Here are some guiding principles when teaching professionalism. First, “institutional leaders should authentically and publicly support teaching professionalism; such support should include adequate resources. Second, the “cognitive base” of professionalism, such as historical roots, definition, values, attributes, behaviors, and associated duties and responsibilities, should be explicitly taught. Moreover, the learning environments (e.g. classrooms, practice labs, and clinical settings) should align with the institution’s mission statement and professionalism precepts. Faculty members are responsible for teaching professionalism, and they should be highly respected colleagues who have direct access to institutional leadership. Finally, all faculty members should be familiar with the “cognitive base” of professionalism and develop appropriate methods for teaching professionalism in their respective settings.4
The methods of teaching professionalism can include didactic lectures, web-based modules, and role modeling. Since didactic lectures are a popular and most common method to deliver large amounts of information, lectures can be enhanced by showing examples of professional and unprofessional behaviors as well as using an audience response system.4 Another great technique in large classroom settings is to present an ethical dilemma and allow learners to discuss potential responses to the dilemma.
Web-based teaching modules are another potential approach to teaching professionalism. Modules consist of learning material and assessments that determine whether students have mastered the content. For example, “pop-up” multiple-choice questions can be embedded in web-based modules. The learner chooses an answer, and based on the result, the module congratulates the learner or provides the correct answer with an explanation. Self-assessment questions have been shown to enhance learning; however, the number of questions per module should be limited.4 These modules could also include online discussions between the instructors and students.
Role modeling is an effective means of teaching professionalism. Role models’ actions should be consistent with formal professionalism curricula.4 Studies suggest that learners watch, embrace, and mimic the attitudes and behaviors of role models.5 Instructors should leverage this phenomenon by using interactions with patients, colleagues, and healthcare team members as opportunities to role model ideal attributes and behaviors. Faculty and preceptors can demonstrate “effective communication such as sitting with the patient, therapeutic touch, and tone of voice.”5 Professional behaviors also include being knowledgeable, prepared, advocating, and involving patients in the plan of care. Faculty and preceptors need to avoid unprofessional behaviors such as blaming others, using their smartphones at inappropriate times, using aggressive body language, chewing gum, being unprepared for patient care or learning activities, and wearing inappropriate attire or being ungroomed.
Assessing professionalism can be done through tests of knowledge, objective clinical examinations, patient feedback, and simulations. Assessments should be relevant to the student's level of education and be collected data for both formative and summative purposes. This data could also be use in professionalism portfolios.4
Professionalism is essential to delivering quality health care and should no longer be the hidden curriculum in health professions education. It must be intentionally taught (and learned). I believe faculty should deliberately create assignments and assessments to teach the next generation of health professionals the importance of professionalism and how to behave as a professional.
References
1. A quote by Miriam Defensor-Santiago [Internet]. Goodreads; [cited 2024 Jun 9]. Available from: https://www.goodreads.com/quotes/6971348-a-true-teacher-does-not-terrorize-ignorant-students-a-true
2. Bhardwaj A. Medical professionalism in the provision of clinical care in healthcare organizations. Journal of Healthcare Leadership. 2022;14:183–9. doi:10.2147/jhl.s383069
3. Professionalism definition & meaning [Internet]. Merriam-Webster; 2024 [cited 2024 Jun 15].
4. Mueller PS. Teaching and assessing professionalism in medical learners and practicing physicians. Rambam Maimonides Medical Journal 2015;6(2):1–10.
5. Bussard ME, Lawrence N. Role modeling to teach communication and professionalism in prelicensure nursing students. Teaching and Learning in Nursing. 2019;14(3):219
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