HealthCommentary

Exploring Human Potential

Advanced Professionalism

Advanced Professionalism Draft Curriculum

Statement of Purpose:

Advanced Professionalism is a multi-disciplinary, interactive, formative educational curriculum which defines health as the pursuit of full human potential and the health professional as a unique professional resource critical to human success. The concept is summarized and placed in historical context through the following 5 sequential essays:

1. Desirable Attributes in Health Care Professionals: ABIM/ACGME/ABM.
2. A Flag In The Wind: A View Standing On Others’ Shoulders: AAMC/Dr.Inui .
3. Best Intentions: The Tavistock Principles and what is the consumers’ role in defining professionalism.
4. Undervisioning Professionalism: Deming, Berwick, & Sensemaking.
5. Consumer Roles:The Role of Consumers in Defining Health Professionalism.

The course is designed to prepare caregivers to meet the professional demands of a modern world. Centered on the patient-health professional relationship and cornerstone values of compassion, understanding and partnership, a modern view of professionalism engages the physicians, nurses and other health professionals in positively impacting the quality of health in the home, the workplace, the community, and the environment. Values define practice; and thoughtful, forward facing, customized and predictive health system design defines potential for success.

Why Now?

The Health Care System in the United States is actively transforming. Health is rapidly becoming synonymous with reaching full human potential. Health care provision has been redefined as a right carrying with it responsibilities for individuals, families and community. Provision of care is increasingly a collaborative effort with individual providers giving ground to health care teams, and consumers joining hands with providers in strategic health planning and mutual decision making. The role of “professionalism” in training of health professionals and delivery of care has been heralded by major scientific bodies including the Institute of Medicine, the ACGME and the ABMS. Their listing of desirable attributes in health care professionals – patient-centered, collaborative, ethical, committed to continuous learning, and armed with a range of measurable knowledge, skill, and comfort with technology and communication to allow an orderly, efficient and effective care process is helpful. But absent the context of rapid environmental change, the modeling of new approaches to care that are emerging from both the consumer and provider side, and the integration of the latest social science concepts which impact human development and potential, health professionals will predictably under perform in the modern world and not fully realize their leadership potential in the future.

Course Components:

1. The history and evolution of professionalism and the patient-health professional relationship.

2. The major intersecting health megatrends.

3. New models of care delivery and technology as a change agent.

4. Health coaching and the Lifespan Planning Record (LPR)

5. Social capital theory, empathy and the roles of the individual, family, community and society in securing health.

6. Process re-engineering in pursuit of safe, effective and efficient care delivery.

7. Managing change and fear and the ethical challenges of the day.

8. Techmanity: embracing technology as a humanizing force.

9. Organizational dynamics, human resource development, and model team formation in varied workplaces.

10. Strategic planning and personalized, prospective and proactive medicine and scientific research.

11. Leadership styles and measuring success.

12. The planetary patient.

Advanced Professionalism: Defining the Issue

1. Desirable Attributes

Desirable Attributes in Health Care Professionals: ABIM/ACGME/ABM

II. A Flag In The Wind

A View Standing On Others’ Shoulders: AAMC/Thomas Inui

III. Best Intentions

What ever happened to the Tavistock Principles and what is the consumers’ role in defining professionalism?

IV. Undervisioning

Under-Visioning Professionalism: Deming, Berwick, & Sensemaking

V. CONSUMER ROLES

The Role of Consumers in Defining Health Professionalism

Critical Questions:

1. What are the valued attributes of a health care professional?
2. Why does Thomas Enui believe health professionals must pursue their work as a “virtuous activity, a moral undertaking”?
3. Who am I becoming as I move toward this life of service?
4. Why am I becoming this as I move toward this life of service?
5. Is unprofessional behavior the result of bad people or bad systems tied to fundamental and foundational flaws in system design?
6. Is it possible to appear professional while being unable to realize professionalism?
7. Is the primary question for health professionals in training, “Who am I becoming?” or “What am I building, how, where, and for whom?”
8. What are the Tavistock principles?
9. What is the role of the health professional in supporting consumer choice and mutual accountability?
10. What is the role of the health consumer in encouraging professional accountability?
11. Is health professionalism possible without active collaboration of all disciplines and active involvement of health consumers?
12. Can a health professional be professional in a fundamentally misaligned system?
13. If presented with a fundamentally misaligned system, must a health professional make an earnest effort at positive transformation to be deemed professional?
14. What is “sensemaking” as defined by Don Berwick and how does it contribute to advanced professionalism?
15. How does Ralph Snyderman’s views on prospective, personalized and preventive care design alter the pursuit of advanced professionalism?
16. What is the role of strategic customized health planning and health coaching in advanced professionalism?
17. What is the responsibility of health professionalism to support the creation of healthy homes and healthy communities?
18. Can an individual be professional is the absence of empathy?
19. Must advanced professional embrace information technology?
20.  Should the consumer help define health professionalism and continually assess health professionals performance as defined by this code?
21. What are the four dimensions of a patient-centered health care system?

Syllabus:

1. American Board of Internal Medicine Foundation.(ABIM) About Professionalism.
http://www.abimfoundation.org/en/Professionalism/About%20Professionalism.aspx

2. American Board of Medical Specialties: ABMS Maintenance of Certification. Six Core Competencies for Quality Patient Care. http://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx

4. ACGME/ABMS Competencies. Advancing Education In Medical Professionalism. ACGME Resource. 2004.
http://www.acgme.org/outcome/implement/Profm_resource.pdf

5.Anderson MB, Cohen JJ, Hallock JE, Kassebaum DG, Turnbull J, Whitcomb M. Learning objectives for medical student education – guidelines for medical schools. Report I of the Medical School Objectives Project. Acad Med 1999;74:13-18. http://www.aamc.org/meded/msop/

6.Accreditation Council for Graduate Medical Education. ACGME Outcome Project. , 1999. http://www.acgme.org/outcome/about/faq.asp

7. Berwick DM. Escape Fire. December 9, 1999. 11th Annual National Forum on Quality Improvement in Health Care. Commonwealth Foundation.
http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf

8. Berwick D, Davidoff F, Hiatt H, Smith R. Refining and Implementing the Tavistock principles for everybody in health care. BMJ 2001; 323 : 616 doi: 10.1136/bmj.323.7313.616 (Published 15 September 2001). http://www.bmj.com/content/323/7313/616.short

9. British Medical Council. Good Medical Practice: Protecting Patients, Guiding Doctors. London, British Medical Council, 1998. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2923.2001.00008.x/abstract

10. Deming, W. Edwards (2000). The New Economics for Industry, Government, Education (2nd ed.). MIT Press. http://www.worldcat.org/oclc/44162616

11.Embedding Professionalism in Medical Education: Assessment as a Tool for Implementation, an invitational conference of the National Board of Medical Examiners and the Association of American Medical Colleges. Baltimore, May 15-17, 2002. http://www.nbme.org/PDF/NBME_AAMC_ProfessReport.pdf

12. Wong RY, Hemmer PA, Szauter K. Student professionalism: A CDIM commentary. Am J Med 1999;107: 537-541. http://www.ingentaconnect.com/content/els/00029343/1999/00000107/00000006/art00333;jsessionid=gh2o0c7hkjn5p.alexandra

13. Evans JH. A sociological account of the growth of principalism. Hastings Center Report.2000;30(5):31–38. http://www.ncbi.nlm.nih.gov/pubmed/11057386

14. FACCT (Foundation For Accountability) 2003 Report, “Innovators and Visionaries: Strategies for Creating a Person-centered Health System”.http://www.markle.org/resources/facct/doclibFiles/documentFile_599.pdf

15. Iglehart JK. Interview: Addressing Both Health And Health Care: An Interview With StevenA.Schroeder.2002.
http://content.healthaffairs.org/cgi/content/full/21/6/244

16. Institute of Medicine Core Competencies: Health Professions Education: A Bridge To Quality. April 18, 2003.
http://www.iom.edu/Reports/2003/Health-Professions-Education-A-Bridge-to-Quality.aspx

17. Institute of Medicine. New Models of Health Care. Summit on Integrative Medicine and the Health of the Public. February, 2009. http://www.imsummitwebcast.org/

18. Inui, TS. A Flag In The Wind: Educating For Professionalism In Medicine. February, 2003. AAMC. https://services.aamc.org/publications/index.cfm?fuseaction=Product.displayForm&prd_id=111&showTopics=true

20. Magee M. “Home-Centered Health Care: The Populist Transformation of American Health Care”, Harvard Health Policy Review, Nov. 2007. 44-52.
http://www.hcs.harvard.edu/~hhpr/currentissue/Fall2007.pdf

21. Magee M. Powering Healthcare Visions: Taking Advantage of Complexity, Connectivity, and Consumerism. Intel Technology Journal. Volume 13, Issue 3, 2009. http://www.intel.com/technology/ITJ/2009/v13i3/ITJ9.3.0-Healthcare-Visions.htm

22. Magee M. Relationship Based Health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan: A Comparative Study of Patient and Physician Perceptions Wordwide. The Journal of Biolaw and Business, Vol. 7, 2003. http://www.mikemagee.org. (access “publications”)

23. Magee M. “The Patient – Provider Relationship” in Connecting With  The New Healthcare Consumer, D. Nash, Ed. McGraw Hill, 1999.
http://www.amazon.com/Connecting-New-Healthcare-Consumer-Defining/dp/0834220040/ref=sr_1_fkmr1_1?ie=UTF8&qid=1264526843&sr=8-1-fkmr1

24. Magee M. “Advanced Professionalism”. Health Commentary. 2010.
1. Desirable Attributes in Health Care Professionals: ABIM/ACGME/ABM.
2. A Flag In The Wind: A View Standing On Others’ Shoulders: AAMC/Dr.Inui .
3. Best Intentions: The Tavistock Principles and what is the consumers’ role in defining professionalism.
4. Undervisioning Professionalism: Deming, Berwick, & Sensemaking.
5. Consumer Roles:The Role of Consumers in Defining Health Professionalism.

25. Mirvis DM. Physicians’ autonomy: the relation between public and professional expectations. N Engl J Med. 1993;328:1346–1349.
http://www.ncbi.nlm.nih.gov/pubmed/8469257.

26. Mirvis DM, Bailey JE. Justice in Health Care Foundation. Commentary: Justice in health care – a response to Tavistock. BMJ. 2001 September 15; 323(7313): 616–620. > Sub-article.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121187/

27.  Members of the Medical Professionalism Project (ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine). Medical professionalism in the new millennium: A physician charter. Ann Int Med 2002;136:243-246. http://www.annals.org/content/136/3/243.full.pdf

28.. Smith R, Hiatt H, Berwick D. Shared ethical principles for everybody in health care: a working draft from the Tavistock Group. BMJ. 1999;318:248–251.
http://www.ncbi.nlm.nih.gov/pubmed/9915738

29. Snyderman R. Yoedionno Z. Prospective Care: A personalized, preventive approach to care. Pharmacogenomics 7: 2006, (19)
http://www.proventys.com/~/media/Proventys/Files/Publications/Prospective_Care-A_Personalized_Preventative_Approach_To_Medicine.ashx

30. Ralph Snyderman, MD; Michaela A. Dinan, BS. Improving health by taking it personally. JAMA. 2010;303(4):363-364. http://jama.ama-assn.org/cgi/content/extract/303/4/363?home=

31. Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000;75: 612-616.
http://journals.lww.com/academicmedicine/Abstract/2000/06000/Toward_a_Normative_Definition_of_Medical.10.aspx

32. Tavistock Group: A shared statement of ethical principles for those who shape and give health care. BMJ. 1999;318:249–251. http://www.bmj.com/content/318/7178/248.full?sid=d161d431-a848-49a3-a4bf-45bcbd5dab27

33.Weick, Karl E . The collapse of sensemaking in organizations:  The Mann Gulch disaster. Administrative Science Quarterly; Dec 1993; 38, 4; ABI/INFORM Global pg. 628 http://www.cs.unibo.it/~ruffino/Letture%20TDPC/K.%20Weick%20-%20The%20collapse%20of%20sensemaking.pdf

34. Cruess RL, Cruess SY, Steinert R.  Teaching Medical Professionalism. Cambridge U. Press, 2008
http://books.google.com/books/about/Teaching_Medical_Professionalism.html?id=WU_uSN1-nykC

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