In addition to teaching residents Family Medicine, I am the course director for the Fundamentals of Doctoring course that is in our first and second year student curriculum. I have the responsibility of offering instruction in “professionalism” to these proto-physicians. Preparing for the course this semester and participating in the instruction being offered over the past 3 weeks has allowed me to reflect on training in professionalism both at the medical student and the residency level.
1) Technical competence is expected: Earle Scarlett observes that the non-technical skills are important in part because the technical skills are expected. It is important to us as a profession to assure our patients a technical product that is predictable, safe and reliable.
2) We must not only say we subjugate our needs to the needs of others, but do it: All of us are almost guaranteed the opportunity to a good income when compared to others in our community and our country. Patients are glad for us to make this living but feel betrayed when they discover that decisions were made with the pocketbook. The medical home concept will allow primary care docs to provide for the health of the community with the incentives aligned correctly.
3) We must be committed to continuing learning and excellence: Prior to the founding of Family Medicine as a specialty, it was assumed that physicians would maintain their knowledge base (or that medical knowledge was static upon completion of residency). Physicians did not share their dirty little secret that medical knowledge was not static but their learing was often dependant on visiting pharmaceutical representatives. Family Medicine was the first specialty to include a retesting of knowledge on a periodic basis. As a specialty we now have several different mechanisms that assure members are maintaining their knowledge and ablity to apply such knowledge.
4) Humanismis in: Time and again we are reminded of the need to communicate with patients at so many different levels. Learning how to communicate effectively and actively doing so leads to improved patient satisfaction, less litigation, and happier physicians. This communication is not limited to being a conversationalist but needs to include the values of honesty, integrety, caring, compassion, altruism, respect, and trustworthiness. These values are difficult (but not impossible) to teach and get little attention in medical schools.
5) We need to be hard on ourselves: The licensing bodies have begun to pay much more attention to performance in training, in part because of increasing evidence that problems in school predict subsequent problems. One of the hallmarks of a profession is accountability and self reflection. As a program director, I find it much easier to work with a resident who has a knowledge base deficit than one that is “non-cognitive”. I hope that the increased emphasis in medical school will lead to improvements at all levels of the profession.
The picture at the beginning of this post demonstrates a hallmark of medical education. It reflects that once trained, physicians see the world differently.