MEDICAL ETHICS AND PROFESsionalism

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					                           MERCER UNIVERSITY SCHOOL OF MEDICINE




     MEDICAL ETHICS AND PROFESSIONALISM: 2009

         Definitions, Principles, Curriculum, and Objectives


                                             1/20/2009




This document defines medical ethics and professionalism, presents ways in which teaching medical
ethics and professionalism differ fundamentally from the teaching in other parts of the medical
curriculum, describes current activities for teaching medical ethics and professionalism, presents
teaching objectives, and proposes additions to current activities.

MUSM Ethics and Professionalism February 2009
Contents



Introduction .................................................................................................................................................. 3

   ACGME, ACP, Medical Ethics, and Professionalism .................................................................................. 4

Medical Ethics and Professionalism as it presently taught at MUSM .......................................................... 6

Proposed additions to the curriculum in Medical Ethics and Professionalism:............................................ 7

Unsatisfactory Ethical and Professional Behavior Incident Report ............................................................ 20

   Description of incident:........................................................................................................................... 20

Exemplary Ethical and Professional Behavior Report ................................................................................. 22

   Description of incident:........................................................................................................................... 22

Proposed Ethics and Professionalism Manual Introduction ....................................................................... 25

Proposed Ethics and Professionalism Oversight Committee ...................................................................... 33

MUSM Dress Code ...................................................................................................................................... 35

Appendix A. Mercer University School of Medicine Medical Student Competencies ............................... 36




                                                                                                                                                               2
Introduction

In 2008 a subcommittee of the Mercer University School of Medicine (MUSM) Curriculum
Instruction Committee (CIC) was created to develop a plan for teaching professionalism. The
goals for the subcommittee included developing an understanding of professionalism in the
medical curriculum, determining what is currently being taught at MUSM that would meet
criteria for professionalism, recognizing needed additions to the curriculum, developing
objectives, and recommending methods for assessment.

The subcommittee met approximately 12 times during 2008, and began a series of
presentations to the CIC. The resulting document is a result of those subcommittee and CIC
meetings. It begins by describing the process used to arrive at our conclusions and
recommendations.

When the committee first met a review of the literature on teaching and evaluating
professionalism was undertaken. To give an idea of the volume of publications and interest
among academics in professionalism, the following shows the results of a PubMed search using
the key word “professionalism” for the years 2000-2008. It shows an increase in publications
through 2006, with perhaps a slight decline in the past two years.

       2008        249
       2007        283
       2006        306
       2005        213
       2004        234
       2003        217
       2002        176
       2001        118
       2000        123


Among the two most influential publications were from the American Colleges of Physicians 1
and the American Council for Graduate Medical Education2 and the subcommittee relied
heavily on these resources.



1
    Medical Professionalism in the New Millennium: A Physician Charter. Ann Intern Med 2002;136:243-246.
2
 ACGME. Advancing Education in Medical Professionalism.
http://www.acgme.org/outcome/implement/profm_resource.pdf

                                                                                                           3
ACGME, ACP, Medical Ethics, and Professionalism


The ACGME is responsible for the accreditation of postgraduate (residency) training programs
in the United States, and, since 2001, has recognized professionalism as among six core
competencies. As these core competencies are mandatory for residency training, we believe
undergraduate training should take ACGME into consideration where feasible.

ACGME operationalizes professionalism as:

Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents are
expected to:
· demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supersedes self-interest; accountability to patients, society, and
the profession; and a commitment to excellence and on-going professional
development.
· demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business
practices
· demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities

The subcommittee was impressed by the overlap between what is commonly taught as medical
ethics (e.g., “adherence to ethical principles . . . commitment to ethical principles . . . provision
or withholding of clinical care, confidentiality of patient information, informed consent”), an
overlap reflected in much of the literature upon which the ACGME report was based.

Another highly influential paper on medical professionalism was from the American College of
Physicians. In their Charter on Medical professionalism, they enunciated three Fundamental
Principles :

Primacy of patient welfare

Patient autonomy

Social justice.

In addition, they described a set of professional responsibilities:

Commitment to professional competence

Commitment to honesty with patients

                                                                                                    4
Commitment to patient confidentiality

Commitment to maintaining appropriate relations
with patients.

Commitment to improving quality of care

Commitment to improving access to care

Commitment to a just distribution of finite resources

Commitment to scientific knowledge

Commitment to maintaining trust by managing conflicts
of interest

Commitment to professional responsibilities

It was again clear that there was considerable overlap between professionalism as described by
the ACP and what is often taught as medical ethics.

In addition to these reports from the ACGME and ACP, subspecialty organizations (e.g.,
pediatrics3, internal medicine4, surgery5) have examined, or are in the process of examining,
professionalism in their disciplines.

From these considerations it was clear that much of what is recognized as professionalism
overlaps with medical ethics, and the subcommittee agreed to recommend that a combined
Ethics and Professionalism Program be created to address both parts of the curriculum. Such a
combined program would:

      1. Bring together faculty with expertise in either or both areas to plan, deliver, monitor,
         and improve the teaching of medical ethics and professionalism.

      2. Reduce unintended redundancy in the teaching of medical ethics and professionalism
         that might result from independent programs in medical ethics and professionalism.




3
    Fallat ME, Glover J, American Academy of Pediactrics Committee on Bioethics. Pediatrics 2007;120:e1123-33
4
    Reference 1
5
    http://www.facs.org/education/tfprofessionalism.html

                                                                                                                5
Medical Ethics and Professionalism as it presently taught at MUSM

Before reviewing current teaching, it should be recognized that the majority of teaching in
medical ethics and professionalism at MUSM and elsewhere is taught informally as part of what
has been described as the “hidden curriculum.” In particular, residents, full-time clinical
faculty, community preceptors, and other attending physicians provide, intentionally or
otherwise, “teaching” (actually role modeling rather than reflective teaching) medical students
about medical ethics and professionalism. This is the greatest weakness in our curriculum, as
little is provided to help this large group of faculty who have such influence over the ethical and
professional development of students. We believe there is an urgent need to develop training
programs for this group so that students might be taught ethical and professional values in a
more intentional manner. We do not present in this program an outline for such a training
program, hope it will be the focus of future efforts, but turn our attention to formal teaching of
medical ethics and professionalism at MUSM.

Aspects of Medical Ethics and Professionalism are taught formally in all four years, as parts of
Medical Ethics, Clinical Skills, PPL, third year clerkships, and emergency medicine in the fourth
year (soon to be a selective, starting Fall 2009).

Topics covered include (abbreviations ME Medical Ethics; CS Clinical Skills) (specific objectives
listed later in this report):

       Abuse of students (M-II ME)

       Advance decisionmaking (M-I ME, M-III ME Internal Medicine)

       Advance decisionmaking (M-III ME Internal Medicine)

       AMA Code of Medical Ethics

       Analysis of ethical issues (M-I ME, M-IV ME)

       Artificial reproduction (M-III ME Ob-Gyn)

       Beginning of life issues (M-III ME Pediatrics)

       Child abuse and neglect (M-III ME Pediatrics)

       Confidentiality (M-I ME)

       Cultural issues (M-I CS History taking, CS Bad News, Community Medicine I Poverty and
       Cultural Issues)

                                                                                                    6
       Domestic violence (M-III ME Family Medicine)

       Duty to third parties (M-III ME Psychiatry)

       End of life ethical issues (M-III ME Internal Medicine, M-III ME Family medicine)

       Ethics in clinical research (M-II ME)

       Futility of care (M-III ME Internal Medicine)

       Genetic testing (M-III ME Ob-Gyn)

       History and fundamentals of professionalism (M-I ME starting 2009)

       Impaired student and physician (M-II ME)

       Informed consent (M-I ME, M-3 Psychiatry)

       Involuntary treatment (M-III ME Psychiatry)

       Law and Medicine (Community medicine II)

       Medical errors (M-III ME Family medicine ?)

       Physician-patient communication (M-I CS History taking, M-IICS Delivering Bad News,
       Mental status examination )

       Physician-patient relationships (M-III ME Psychiatry)

       Principles of medical ethics (M-I ME, M-3 Surgery)

       Professionalism, history of and introduction to (M-I ME)

       Relations with pharmaceutical industry (M-II ME)

       Surrogate decisionmaking (M-I ME, M-III ME Internal Medicine)

In addition, case conferences are held for students on emergency medicine, pediatrics, surgery,
and Ob-Gyn rotations which discuss ethical issues related to those specialties,.

Proposed additions to the curriculum in Medical Ethics and Professionalism:

We propose that additions be made to the orientation of first year students to include
professionalism in dress, punctuality, relationships with students and faculty, recognizing and


                                                                                                  7
intervening with potential impairment among students and faculty, and commitment to life-
long learning and the PBL model.

We propose that additions be made to the orientation of third year students to include
relationships with other health care professionals, relationships with attending physicians, the
role of the medical student in the health care system (i.e., coping with medically unnecessary
teaching procedures), and cultural issues in a clinical setting.

We strongly support the addition of a Capstone component to the fourth year. Issues in
Medical Ethics and professionalism which we could cover in eight hours (two half-days) include:

Medical errors

Risk management

Access to medical care and U.S. health care policy

Cultural issues in health care




                                                                                                   8
Ethics and Professionalism Curriculum



1.       An introductory description of the Ethics and Professionalism Program and its attributes will be
     provided during the orientation phase for freshman students and each required
     program/clerkship/course will have a unique ethics and/or professionalism component.
        Orientation

        Overview of the Ethics and Professionalism Program

        (V-3, V-4. V-6, V-7, V-8, V-16, V-17)

        Purpose:

        To provide an introductory overview of the principles of ethics and professionalism, to provide a
        review of the methods of delivery for the ethics and professionalism curriculum and to provide
        an overview of the evaluation and remediation process.

        Objectives:

        Overview of the Ethics and Professionalism Program

                         Review the Definition and Principles of Ethics
                         Review the Definition and Principles of Professionalism
                         Review the Code of Conduct (Handbook)
                         Review the Personal, Ethical, Professional, Leadership (PEPL) Program
                         Review the evaluation and remediation process
        Methods:

        Information will be provided during orientation by dissemination of the handbook, by a one
        hour didactic session given by the Ethics and Professionalism Program Director and a brief
        question and answer session at the conclusion of the lecture.



Year One

        Introduction to the Principles of Medical Ethics and Professionalism

        (V-4. V-6, V-7, V-8, V-14, V-16)

        Purpose:

        To provide a general introduction to the varied issues surrounding medical ethics and
        Professionalism

                                                                                                       9
Goals:



1. To understand the importance of ethics and professionalism in the practice of medicine
2. To understand the four principles of medical ethics
3. To understand the process of analyzing an ethical case
4. To know several sources of information regarding the legal regulation of medical practice
5. To understand the relationship between medical ethics and medical professionalism
6. To understand ethical and legal concepts relating to informed consent, surrogate
   decisionmaking, and advance directives
7. To understand ethical and legal concepts relating to confidentiality
8. To recognize the importance of the AMA’s Principles of Medical Ethics




Objectives: At the conclusion of the phase, students will be able to:

               Define medical ethics and professionalism
               Describe the relationship between ethics and professionalism
               List and describe four principles of medical ethics
               Be able to present orally a case analysis of an ethically problematic using the
                Mercer Ethical Case Analysis form
               Discuss the three elements essential to informed consent
               Discuss the ethical principles underlying informed consent
               Discuss the value of informed consent in relationships with patients
               Discuss exceptions to informed consent
               Discuss the concepts of advance directives, surrogate decisionmaking, living will,
                and power of attorney
               Distinguish statutory and case law
               Find the Official Code of Georgia pertaining to informed consent and be able to
                apply this to the analysis of a case of informed consent and surrogate
                decisionmaking
               Recognize the importance of the cases of Karen Ann Quinlan and Nancy Cruzan
                in the evolution of law regarding withdrawal of life supports and surrogate
                decisionmaking
               Analyze a case involving informed consent and surrogate decisionmaking
               Discuss the role of confidentiality in medical professionalism
               Discuss the ethical principles underlying confidentiality in medicine
               Analyze a case involving confidentiality in medicine
               Recognize the AMA’s Principles of Medical Ethics
               Apply the AMA’s Principles of Medical Ethics to the analysis of cases involving
                informed consent and confidentiality

                                                                                               10
      Methods:

      Information will be provided during two large group didactic sessions to allow for an overview of
      topics related to ethics. Additional resources will be provided on the MUSM Medical Ethics web
      site. The students along with faculty facilitators will then break into small groups for case
      studies and discussion of principles and practices of medical ethics and medical professionalism.

      Topics to be covered include:

                     General Principles of Medical Ethics
                     Confidentiality, Keeping Secrets, and Duties to Report
                     Informed Consent, Advance Directives and Surrogate Decision Making
                     Introduction to Ethical Case Analysis
                     Relationships between Medical Ethics and Medical Professionalism


      Assessment

      At the end of the phase there will be a written examination to include multiple choice and short
      answer questions.

Year Two

      Principles of Medical Ethics and Medical Professionalism Part II

      (V-1, V-2, V-3, V-4, V-5, V-6, V-7, V-8, V-14, V-16, V-17)

      Purpose:

      To continue to provide the foundational principles needed to practice in an ethical and
      professional manner.

      Objectives: At the end of the phase students will be able to:

                     Describe ethical problems associated with the Tuskegee Syphilis Study
                     Discuss the nature and responsibilities of Institutional Review Boards
                     Analyze three cases involving ethical issues and experimental treatments
                     Demonstrate professional behavior and patient respect when working with
                      patients (or colleagues) with substance abuse disorders.
                     Describe issues associated with substance abuse and addictive disorders among
                      health professionals.
                     Explain the ethical responsibility for reporting impaired physicians.
                     Discuss the interactions of the pharmaceutical industry with the medical
                      community.
                     Discuss ethical responses to offers from pharmaceutical company
                      representatives.
                     Discuss the basic requirements of ethical research and human subjects.
                                                                                                    11
                        Discuss the legal aspects of medical care including the duty to report, medical
                         malpractice, interactions with the medical board and legal testimony.
       Methods

       Information will be provided during three large group didactic sessions to allow for an overview
       of topics related to ethics. The students along with faculty facilitators will then break into small
       groups (10-15 students) for case studies and/or discussion questions on the day’s topic.

       Topics to be covered include:

                        Pharmaceutical Industry and Physician Interactions
                        Ethics and Clinical Research
                        Abuse of Medical Students and Residents
                        Recognizing and Responding to the Impaired Student or Physician
       Assessment

                        Submission of a paper analyzing one of three cases involving clinical research
                        Written examination to include multiple choice and short answer questions


Year Three: Ethics and Professionalism in the Clerkships

       (V-1, V-2, V-4, V-5, V-6, V-7, V-8, V-9, V-10, V-11, V-12, V-13, V-15, V-16)

       Family Medicine Clerkship

       Domestic Violence and Geriatrics

       (V-1, V-2, V-3, V-4, V-5, V-6, V-7, V-8, V-14, V-16, V-17)

       Purpose:

       To continue to provide the foundational principles needed to operate as a professional physician
       when confronting child abuse or domestic violence

       Objectives:

              Students will review the laws and their ethical obligations concerning violence and
               confidentiality.
              Students will be able to list state reporting requirements for child abuse, intimate
               partner violence, elder abuse, abuse of vulnerable adults, and assault with a weapon.
              Students will be able to describe the principles that apply to patient confidentiality for
               victims.
              Students will discuss their own attitudes and feelings concerning violence.
              Students will discuss their own attitudes and feelings about family violence,
               including the possibility of their own as well as friends' or family members'
               victimization and the need to address ongoing issues arising from such experiences.
                                                                                                          12
   Students will discuss the potential for abuse in the medical workplace and in the
    educational process.
   Students will recognize their own reactions to end of life issues and how this may
    impact their approach to patients.
   Students will reflect on their own attitudes, beliefs, and experiences with death,
    dying and bereavement.
   Students will discuss the importance of truth telling when providing bad news to
    patients and their families.
   Students will understand that both physicians and patients bring attitudes and
    emotions, styles, beliefs, and culture to encounters that may have significant impact
    upon doctor-patient interactions and outcomes.
   Students will discuss the major issues surrounding the interaction of spirituality and
    medicine.




                                                                                       13
Topics to be covered include:

                 Violence and Abuse
                 End of Life Care
                 Students will demonstrate a commitment to carrying out the professional
                  responsibilities, adherence to ethical principles, and sensitivity required to
                  provide culturally effective care to the elderly.
                 Students will describe the various myths and stereotypes related to older
                  people, recognizing their impact can adversely affect optimal care of elderly
                  patients and be aware of their own attitudes about aging, disability, and
                  death.
                 Students will discuss the application of ethical principles pertaining to the
                  provision of withholding clinical care for the elderly.
                 Students will discuss the awareness of the cultural aspects of aging,
                  including being familiar with the influence of culture and ethnicity on the
                  aging process, health and disease perception, and medical care.
Methods:

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Obstetrics and Gynecology Clerkship

Objectives:

                 Students will discuss ethical principles of genetic testing and working with
                  genetic information.
                 Students will discuss the ethical and social implications of genetic testing.
                 Students will discuss the implications for patient confidentiality when family
                  members receive care at the same health care facility.
                 Students will discuss the rationale for the claim that health care providers
                  may have a duty to disclose information about genetic risk to family
                  members.
                 Students will discuss the ethical ramifications of technology and
                  reproduction.
Methods:

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Topic to be covered:

                 Genetic Testing
                 Reproductive Technologies

                                                                                             14
Pediatrics Clerkship

Objectives:

                  The student will discuss the care of the neonate and the ethical considerations
                   of ill, malformed and premature neonates.
                  The student will discuss futility of care in relationship to the care of neonates.
                  The student will discuss the legal rights and the ethical rights of minors.
                  The student will discuss appropriate disclosure of confidential information in the
                   care of minors.
                  The student will be able to discuss keys to recognizing child abuse and neglect
                  The student will be able to discuss reporting requirements for child abuse and
                   neglect
Methods:

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Topic to be covered:

                  Ethical Considerations in the care of the Neonate
                  Rights of Minors


Internal Medicine Clerkship

Objectives :

                  The student will discuss ethical and professional issues surrounding the
                   provision of end of life care, physician assisted suicide and provision of care at
                   the point of futility of care.
                  The student will discuss the legal ramifications of provision of care at the end of
                   life.
Methods :

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Topic to be covered:

                  End of Life Care
                  Physician Assisted Suicide
                  Futility of Care


Surgery Clerkship


                                                                                                   15
Objectives :

                  The student will be able to discuss the ethical considerations of a surgical case.
Methods :

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Topic to be covered:

                  Topic chosen from cases encountered during the phase




Psychiatry Clerkship

Objectives :

                  The student will review the Code of Medical Ethics from the American
                   Medical Association and the American Psychiatric Association Links.
                  The student will discuss beneficence, non-malfeasance, autonomy, and
                   justice.
                  The student will discuss the assessment to determine capacity to make a
                   medical decision including the clinical approach, the Georgia Legal Code,
                   and the Candura case.
                  The student will discuss issues surrounding appropriate and
                   inappropriate boundaries.
                  The student will discuss the limits on confidentiality and the duty to warn
                   officials in the case of potential harm to self or others.
                  The student will discuss involuntary commitment, the process and the
                   rationale for commitment and potential legal ramifications of
                   commitment.
Methods :

Information will be provided during didactic sessions and during case-based discussions by
clerkship faculty.

Topic to be covered:

                  Principles of Medical Ethics
                  Assessment of Capacity to Make a Medical Decision
                                                                                                    16
                        Boundary Problems
                        Limits on Confidentiality—The Duty to Warn
                        Involuntary Civil Commitment
Year Four

       Emergency Medicine Selective

       (V-1, V-2, V-4, V-5, V-6, V-7, V-8, V-9, V-11, V-16)

       Purpose:

       To provide an educational opportunity that would allow the student to experience the unique
       ethical and professional dilemmas encountered in Emergency Medicine.

       Objectives:

                        The student will submit a case posing ethical challenges and will participate in
                         group discussions centered around cases encountered during the phase that
                         exemplify the ethical and professional dilemmas experienced in Emergency
                         Medicine.
                        Examples of cases commonly presenting ethical challenges in emergency
                         settings include, but are not limited to: drug-seeking behaviors, EMTALA issues,
                         “difficult patients,” futility of care, and allocation of resources in congested
                         emergency settings.
       Methods:

       Small group sessions will be utilized to discuss and review cases relevant to the ethical and
       professional dilemmas experienced in Emergency Medicine.

       Senior Ethics and Professionalism (proposed)

       (V-3, V-4, V-6, V-7, V-8, V-14, V-16)

       Purpose

       To provide an educational opportunity that would complete the framework needed to establish
       a foundation of ethical and professional characteristics needed as the student begins their
       medical career.

       Objectives:

                        Students will discuss the nature, prevalence and outcome of medical errors.
                        Students will be able to describe the U.S. health care system and be able to
                         compare and contrast it with other national health care systems
                        Students will be able to describe strengths and weaknesses of the U.S. health
                         care system and challenges facing it.


                                                                                                      17
                Students will discuss the legal foundations to malpractice and means of
                reducing risk
               Students will present orally and in writing a case illustrating an aspect involving
                cultural diversity in medicine.
Methods:

Brief large-group sessions will be provided to allow for an overview of topics related to ethics
and professionalism. The students and faculty facilitators will then break into smaller groups
(10-15 students) to discuss related cases or discussion questions.

The topics covered will include:

               Medical errors, malpractice, risk management, and a mock trial
               Access to care and U.S. health care policy
               Cultural issues in health care




                                                                                                18
Evaluation of Ethical and Professional Behavior Form

                           Unacceptable                    Acceptable

Patient and provider       1. Does not meet the            The student consistently introduces self, is
communications             criteria for acceptable or 2.   pleasant in communications with patients
                           The student                     and colleagues, guards patient information
(IV-1, IV-2, IV-3, IV-4;   inappropriately disclosed       from disclosure and seeks permission to
V-2, V-7, V-12, V-15,      patient information on          disclose information to other parties, and
V-16,                      more than 1 documented          speaks effectively and respectfully.
V-17)                      occasion or

                           3. The student made
                           inappropriate/public
                           remarks about a colleague
                           or a patient on more than
                           1 documented occasion.

Appearance, attire         Does not meet the criteria      The student consistently wears clothing
                           for acceptable or violates      that is professional in appearance
(V-6)                      the MUSM dress code on          (appropriate to the culture of the
                           more than 1 documented          institution as defined by the preceptor, site
                           occasion.                       dress code, and professional norms), is
                                                           well groomed and wears name badge.

Reliability, motivation Unreliable, shirks                 Timely, accepts responsibilities, fulfills
and responsibility      responsibility,                    obligations
                        disinterested, or
(V-4, V-9,V-10,         unmotivated on more than
V-11, V-13, V-14)       1 documented occasion.




Interpersonal              Lacks respect,                  Communicates well, respectful, collegial
relationships              uncooperative, or
                           manipulative on more
(V-1, V-8)                 than 1 documented
                           occasion.

Accepts instruction        Actively rebuffs, avoids        Open to feedback and constructive
and                        change, or does not             criticism, willing and able to change
                           recognize own limitations
Feedback

                                                                                                           19
(V-3, V-5)              on more than 1 occasion.

Comments:

Areas for Improvement:

             Unsatisfactory Ethical and Professional Behavior Incident Report

The purpose of the Unsatisfactory Ethical and Professional Behavior Incident Report is to enable faculty
to document an individual incident indicative of problem behavior by a student. This report will be
confidentially relayed to the Ethics and Professionalism Oversight Committee and will come to the
attention of the Dean for Student Affairs. The goal of this reporting activity is to allow feedback,
remediation, and improvement in professional behavior.


______________________________                  _____________________________

Student name (please print)                             Date of incident



______________________________                  _____________________________

Faculty name (please print)                             Faculty signature

                                                _____________________________

                                                Department & Contact Information

Description of incident:
(May attach document) ___________________________________________________



_______________________________________________________________________



_______________________________________________________________________



_______________________________________________________________________



Indicate which of the following categories of professionalism behaviors were involved. (Check all that
apply)
                                                                                                         20
            Patient and Provider Communications
            Appearance and Attire
            Responsibility, Motivation and Responsibility
            Interpersonal Relationships
            Accepting Instruction and Feedback


Rate the degree of concern by circling one of the following:



1                  2                  3                      4            5

barely                                                                  severe

acceptable                                                             problem




Documentation of discussion with student



Date:    ______________          Signature of Student:   ______________________________



Signature of Faculty member or Dean for Student Affairs: _______________________________




                                                                                           21
                     Exemplary Ethical and Professional Behavior Report

The purpose of the Exemplary Ethical and Professional Behavior Report is to enable faculty to document
an individual incident indicative of excellent professional behavior by a student. This report will be
confidentially relayed to the Ethics and Professionalism Oversight Committee and will come to the
attention of the Dean for Student Affairs. The goal of this reporting activity is to acknowledge
professional excellence in order to promote the student’s further professional development and to
facilitate role modeling and motivation in other students.


______________________________                  _____________________________

Student name (please print)                             Date of incident



______________________________                  _____________________________

Faculty name (please print)                             Faculty signature

                                                _____________________________

                                                Department & Contact Information

Description of incident:
(May attach document)____ _______________________________________________



_______________________________________________________________________



_______________________________________________________________________



_______________________________________________________________________



Indicate which of the following categories of professionalism behaviors were involved. (Check all that
apply)

           Patient and Provider Communications
           Appearance and Attire
           Responsibility, Motivation and Responsibility

                                                                                                         22
           Interpersonal Relationships
           Accepting Instruction and Feedback


Rate the degree of exemplar performance by circling one of the following:



1                 2                  3                  4                   5

Above                                                                           Highly

Expectations                                                                    Excellent




Documentation of discussion with student



Date:   ______________         Signature of Student:   ______________________________



Signature of Faculty member or Dean of Student Affairs: _______________________________



    2. Ethics and Professionalism assessment and evaluation records for each student are compiled
       and retained in Academic Records.
    3. Students are expected to demonstrate acceptable levels of ethical and professional behavior in
       order to advance in the curriculum and to graduate.
    4. The remediation program supports students who are not demonstrating acceptable levels of
       ethical and professional behavior.
        Remediation Program

         A. Any student scoring an ‘unacceptable’ on any component of the Ethics and Professionalism
    Curriculum will be required to complete a personalized     remediation program or will be referred
    to the SAPC with possible dismissal. Unsuccessful completion of the remediation program will result
    in a referral to the SAPC with possible dismissal.

        B. The personalized remediation program will include:



                                                                                                    23
    -the student will be paired with a faculty mentor from the members of the faculty  on the
Ethics and Professionalism Oversight Committee to oversee the      remediation plan and advise
the student.

   -the student will be required to undergo an independent psychological evaluation.

    -the student will be required to meet all requirements of the program/clerkship that issued the
‘unacceptable’ grade.




                                                                                                24
Proposed Ethics and Professionalism Manual Introduction

The following is a proposed introduction to an Ethics and professionalism manual

Mercer University School of Medicine (MUSM) and its administration, faculty, and staff are committed
to providing the educational experience for students to become competent physicians. The institutional
competencies expected of our graduates include not only basic science and clinical knowledge, clinical
skills, and interpersonal skills, but also include demonstration of ethical behavior and professionalism
that is hallmark of competent physicians. MUSM’s curriculum puts emphasis on the importance of
embedding the core attributes of ethics and professionalism, as expressed through the institutional
competencies and course learning objectives, into the medical school curriculum where such core
attributes will serve as a base and a framework for the development of ethical behavior and
professionalism throughout the student’s medical career.

Goals

1.      Professionalism and its core attributes will be clearly defined.
2.      The medical school will have an institutional commitment to Professionalism.
3.      Professionalism will be expressed and supported by the administration, the faculty, and the
        students.
4.      The medical school will have an explicit longitudinal ethics and professionalism curriculum,
        including assessment and evaluation.
5.      Ethics and Professionalism will be incorporated into all components of the curriculum.

6.      Ethics and Professionalism will be embedded into the curriculum through the competencies.




                                                                                                     25
Definitions

Medical Ethics is the set of rules, values or standards governing the conduct of a person or the conduct
of the members of the medical profession.

These rules, values and standards do not give answers as to how to handle a particular situation, but
provide a useful framework for understanding conflicts.

ethics. (n.d.). The American Heritage® Stedman's Medical Dictionary. Retrieved October 08, 2008, from Dictionary.com
website: http://dictionary.reference.com/browse/ethics

Medical Professionalism is the demonstration of the qualities, traits, and behaviors requisite and innate
to the calling of medicine manifested in the AMA Code of Ethics and the MUSM Code of Conduct.

The basic characteristics of professionalism are the acquisition of a useful body of knowledge and the
altruistic application of that knowledge for the betterment of society.

Description and Core Attributes

Medical Ethics

The medical profession has long subscribed to a body of ethical statements developed primarily
for the benefit of the patient. As a member of this profession, a physician must recognize a
responsibility to patients first and foremost, as well as to society, to other healthcare
professionals, and to oneself. The following Principles adopted by the American Medical
Association are not laws, but standards of conduct which define the essentials of honorable
behavior for the physician.

Principles of Medical Ethics

A physician shall be dedicated to providing competent medical care, with compassion and respect for
human dignity and rights.

A physician shall uphold the standards of professionalism, be honest in all professional interactions, and
strive to report physicians deficient in character or competence, or engaging in fraud or deception, to
appropriate entities.

A physician shall respect the law and also recognize a responsibility to seek changes in those
requirements which are contrary to the best interests of the patient.

A physician shall respect the rights of patients, colleagues, and other healthcare professionals, and shall
safeguard patient confidences and privacy within the constraints of the law.




                                                                                                                   26
A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to
medical education, make relevant information available to patients, colleagues, and the public, obtain
consultation, and use the talents of other health professionals when indicated.

A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose
whom to serve, with whom to associate, and the environment in which to provide medical care.

A physician shall recognize a responsibility to participate in activities contributing to the improvement of
the community and the betterment of public health.

A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

A physician shall support access to medical care for all people.

Adopted by the AMA's House of Delegates June 17, 2001.

Medical Professionalism

Professionalism in medicine requires the physician to serve the interests of the patient above his or her
self-interest. Similarly, professionalism in medical school requires the students to commit to
developing, cultivating, and incorporating the attributes of professionalism from the onset of medical
school and throughout their careers. The attributes of professionalism include altruism, accountability
and professional responsibility, respect, duty, service, integrity, honesty, and social responsibility. As
the student is a constant representative of MUSM and the Profession, professionalism attributes must
extend beyond the classroom or clinical setting into the community as a whole.

Core Attributes of Medical Professionalism

Altruism is an essential attribute of professionalism. The best interest of patients, rather than self-
interest, is the rule and it is exemplified by the unselfish regard for others as a principle of action.

Accountability and Professional Responsibility is required at many levels: with fellow students, faculty,
staff, patients, the profession, the community, and society. Sound medical practice and good medical
care of patients are the student’s and the physician’s highest priority. To achieve these goals, the
student must maintain internal motivation to place patients’ needs and concerns before his or her own.
There also must be ever-present motivation for competence and self-improvement, the attainment of
high levels of knowledge and skills in the medical field, and the ability to use knowledge and skills
appropriately and efficiently. Students must acquire the skills of self-directed learning and the desire to
apply these skills throughout their medical careers. Physicians are accountable to their patients for
fulfilling the implied contract governing the patient/physician relationship. They are also accountable to
society for addressing the health needs of the public and to their profession for adhering to medicine's
time-honored ethical precepts.


                                                                                                         27
Respect: Interpersonal skills must be acquired and expressed, including those of respect for fellow
students, faculty, staff, and patients. Respect for colleagues and the profession also includes attendance
at activities at which he or she is expected, punctuality, effective communication skills, and appropriate
dress. Students shall display courteous behavior and shall respect the dignity, privacy, cultural values,
and confidentiality of patients as well as fellow students. Students should demonstrate sensitivity,
compassion, respect, empathy, and emotional support to patients, as well as their families and
concerned others.

Duty is the free acceptance of a commitment to accountability, responsibility, and service to patients,
peers, and societal needs. As commitment, it entails being available and responsive when 'on call',
accepting inconvenience to meet the needs of one's patients, advocating the best possible care
regardless of the ability to pay, seeking active roles in professional organizations, and providing one's
skills and expertise for the welfare of the community.

Integrity is the consistent regard for the highest standards of behavior and the refusal to violate one's
personal and professional codes. Integrity implies being fair, being truthful, being sincere, meeting
commitments, and being straightforward.

Honesty: Medical professionals are committed to honesty at all times, including their interactions with
patients, their families, other professional colleagues, and peers. Absolute honesty regarding written
notes entered into patients’ records and in oral presentation of findings is expected; medical findings
are true, complete, and verifiable. This attribute includes the responsibility for reporting dishonesty of
others. As with other core values, honesty is not limited to MUSM and its teaching affiliates.

Social Responsibility: Societies place physicians in positions of power and authority, with control over
patients’ and their families’ well-being, as well as over their lives. We must always conduct ourselves in
a manner worthy of that trust. Medical professionals must earn the trust. The process of earning trust
requires becoming aware of, demonstrating concern for, and being responsive to social ills and other
factors which detract from the medical, cultural, spiritual, and emotional health of patients.

Derived from the ACIM, ACP guidelines 2002.




Challenges

Challenges to Professionalism: In addition to the positive attributes of Professionalism, it is important
that one recognizes behaviors and attributes which can be expressed as challenges to professionalism.
These include but are not limited to the following:



                        Abuse of Power
                        Discrimination, Bias and Harassment
                        Breach of Confidentiality
                                                                                                       28
                       Arrogance
                       Misrepresentation
                       Impairment
                       Lack of Conscientiousness
                       Unmet Professional Responsibility
                       Lack of Effort Toward Self-Improvement
                       Poor or Disrespectful Interactions with Peers, Faculty, Staff, and Patients
                       Dishonesty


Professional Non-virtues (Seven deadly sins of the professional)

                       Greed (pursuit of money, power or fame)
                       Abuse of power (patients, colleagues or position)
                       Arrogance (towards patients or colleagues)
                       Conflict of interest (financial, industry)
                       Misrepresentation (lying, fraud)
                       Apathy (lack of commitment, irresponsible or doing only the minimum)
                       Impairment (drugs, alcohol, age, illness, fatigue)
                    
Curricular Expression

Ethics and professionalism and their core attributes will be explicitly expressed in all components of the
curriculum through the competencies. The explicit expression will consist of presentations during
orientation, in the White-Coat Ceremony, in separate didactic sessions, in all of the curricular
components throughout the four years of medical school, and at the time of graduation when an oath of
medicine is taken. Ethical behavior and professionalism will be expressed within the everyday activities
of medical education, when all interactions between fellow-students, faculty, staff, and patients are
built around and incorporate professional behavior. For most medical students, it is expected that most
or all of the attributes of ethics and professionalism are self-evident and self-expressed on a day-to-day
basis. The Ethics and Professionalism Curriculum formally recognizes and integrates the components of
ethics and professionalism and emphasizes their importance on an ongoing life-long commitment to the
practice of medicine.

The school recognizes that there are essential behaviors and attributes that cannot be reasonably
evaluated for most students in the medical school setting. Two salient and important examples are (1) a
physician’s or medical student’s ethical and professional responsibilities and duties with regard to
impairment, and (2) a physician or medical student’s responsibility to avoid unlawful activities or
behaviors outside of the realm of medical practice that impact the individual’s and the profession’s
standing within the community or the individual’s ability to obtain/maintain a medical license.

The medical student’s ethical and professional duties and responsibilities in the areas of impairment and
unlawful behavior are covered in the student handbook.


                                                                                                       29
Note: Adapted in part from American Board of Internal Medicine (ABIM) (Project Professionalism), Wayne State University
School of Medicine (The Professionalism Curriculum), the University of Kansas School of Medicine (Professionalism Initiative),
the University of Toronto Faculty of Medicine (Evaluation), and AAMC and NBME (Embedding Professionalism in Medical
Education).

Program Objectives

         The objectives for the Ethics and Professionalism curriculum shall include but not be limited to
the following (associated competencies follow each objective):

         A. Responsibility for Professional Development

                   -demonstrates self-directed learning. III-8

                   -accepts constructive feedback. V-5

                   -commits to self-improvement in knowledge and work habits. V-5, V-3

                   -recognizes own limits and seeks help when necessary. V-11, I-9

                   -incorporates feedback into behavioral changes. V-5

                   -prepares ahead for the learning situation. V-3

                   -researches information needed for patient’s case. V-9

                   -attends rounds, seminars, and other learning events. V-3

         B. Altruism and Social Responsibility

                   -demonstrates sensitivity to needs of others. V-1

                   -listens respectfully. IV-2

                   -takes time to support other students in the learning environment. V-10,

                   V-8

                   -takes time to explain information to others. IV-3

                   -takes time to explain information to patients. IV-3

                   -puts patients’ interests above his/her own. V-1

                   -shows respect for patients’ confidentiality. V-12

         C. Accountability, Service, and Devotion to Duty

                   -attends all sessions or provides appropriate excuse for absence. V-2

                                                                                                                           30
        -arrives at sessions on time. V-2

        -fulfills obligations undertaken. V-2

        -takes on an appropriate share of group work. IV-4, V-8

        -participates actively in discussions. IV-3

        -completes assigned tasks timely and fully. V-2

        -takes on an appropriate share of team work. IV-4, V-8

        -fulfills call duties. V-2

       -reports/documents accurately and fully on patient care
responsibilities. IV-3

        -ensures transfer of responsibility for patient care. I-15

        -informs supervisor/team when mistakes occur. V-5

        -informs supervisor/team when faced with a conflict of interest. V-14

        -demonstrates concern for patient safety. V-1

D. Respect for Self and Others

        -establishes rapport with fellow students. V-7

        -maintains appropriate relationships in work and learning situations. V-6

        -relates appropriately to fellow students in a learning environment. V-7

        -relates appropriately to faculty in a learning environment. IV-4

        -respects diversity of race, gender, sexual orientation, age, disability,   intelligence and
socio-economic status. V-17, V-15

        -uses professional language in discussing cases. V-7

        -resolves conflicts in a manner that respects the dignity of those involved.       V-16,
V-13, V-15

        -dresses and presents self in an appropriate manner for the situation. V-6

E. Honesty and Integrity

        -behaves honestly. V-4

                                                                                                   31
-adheres to MUSM student honor code. V-3




                                           32
Proposed Ethics and Professionalism Oversight Committee

The Ethics and Professionalism Oversight Committee has responsibility for oversight of the
professionalism curriculum.
        The Ethics and Professionalism Oversight Committee is composed of nine members determined
as follows:

              Program Director: Appointed by Dean.
              Five active members of faculty, one elected from each academic program by the
               medical school faculty.


               BMP

               Community Medicine

               Fundamentals of Clinical Practice Program

               Year 3

               Year 4

               Terms will be two years, with eligibility for reappointment.

              One member from library faculty, elected from the library faculty by the medical school
               faculty.
               Term will be two years. Eligible for reappointment.

              Two students, one representing years one and two, and one representing years three
               and four. Student Council annually will determine student representatives.
              At least 2 members of this committee will be from the Macon Campus and at least 2
               members of this committee will be from the Savannah Campus.


Functions of the Ethics and Professionalism Oversight Committee are as follows:

              Oversight of Ethics and Professionalism Curriculum.
              Ensure a longitudinal Ethics and Professionalism Curriculum across all programs.
              Ensure a longitudinal assessment of ethics and professionalism across all required
               programs.
              Uphold ethics and professionalism standards as approved by the faculty.
              Coordinate remediation for students with unsatisfactory performance in the Ethics and
               Professionalism curriculum.

The Ethics and Professionalism Oversight Committee will meet not less than quarterly to review all
Evaluation of Ethical and Profession Behavior Forms, Unsatisfactory Ethical and Professional Behavior
Incident Reports and Exemplary Ethical and Professional Behavior Reports. The committee will
                                                                                                   33
designate a secretary to cause minutes to be kept of all proceedings. These minutes will be provided to
the Dean of Academic Affairs. All minutes of the Ethics and Professionalism Oversight Committee will be
confidential and all discussions of specific student behaviors will be made in executive session.
       Transfer students will have customized orientation to the Ethics and Professionalism curriculum
       at time of matriculation.




                                                                                                    34
MUSM Dress Code

Policy Statement:

Mercer University School of Medicine requires faculty, staff and students to dress in such a manner as to
present a positive image of the organization. The School’s philosophy is a conservative and professional
appearance appropriate for the activities required to carry out the expected duties. All faculty, staff and
students are expected to be neat, clean and presentable at all times. The dress code recognizes that
different styles and clothing will be necessary, depending upon the nature of the work, safety issues,
contact with the public and patient contact.

Dress Code:

A. Attire-

All clothing must be clean and neat. Proper undergarments must be worn and should not be visible
through the clothing being worn. Tank tops, halter tops, midriff tops, or tops/dresses with spaghetti
straps will not be permitted.

B. Hair-

Hair should be kept in accordance to the rules of the medical institution sponsoring rotations and/or in
accordance to laboratory regulations.

C. Nails-

Nails should be trimmed in accordance to the rules of the medical institution sponsoring rotations
and/or in accordance to laboratory regulations.

D. Jewelry-

Jewelry should be worn in accordance to the rules of the medical institution sponsoring rotations and/or
in accordance to laboratory regulations.

E. Footwear

Shoes must be worn at all times and should be worn in accordance to the rules of the medical institution
sponsoring rotations and/or in accordance to laboratory regulations.

A photo ID is to be worn at all times while at the medical school or while in any of the clinical settings.
Identification badges should be worn in accordance to the policies of the medical institution sponsoring
rotations.




                                                                                                        35
Appendix A. Mercer University School of Medicine Medical Student Competencies

The student graduating with a Doctor of Medicine degree from MUSM will be able to perform the duties
required of a resident entering training by demonstration of the following competencies:

I. Patient Care

  Students must be able to participate in the provision of family centered patient care that is
compassionate, appropriate, and effective for the treatment of health problems and the promotion of
health. Students are expected to:

    1. Communicate effectively and demonstrate caring and respectful behaviors when interacting
        with patients and their families.
    2. Relate to patients with consideration of privacy, dignity and psychological needs.
    3. Obtain a focused and comprehensive medical history accurately and efficiently.
    4. Perform a focused and comprehensive physical examination accurately, efficiently and
        respectfully.
    5. Perform appropriate clinical and laboratory studies.
    6. Interpret results of common laboratory studies.
    7. Demonstrate the ability to use information technology to support patient care decisions and
        patient education.
    8. Demonstrate the ability to recognize personal limitations and biases and to seek
        consultation/help when appropriate.
    9. Develop and discuss patient management plans for common medical problems.
    10. Relieve pain and suffering in patients.
    11. Recognize life-threatening emergencies and know appropriate initial intervention.
    12. Demonstrate effective patient education/counseling skills.
    13. Provide health care services aimed at preventing health problems or maintaining health.
    14. Work with health care professionals, including those from other disciplines, to provide patient-
        focused care.


II. Medical Knowledge

Students must demonstrate knowledge about established and evolving biomedical, clinical, and cognate
(epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
Students are expected to:

    1. Demonstrate an investigatory and analytic thinking method that approaches clinical problems in
       a logical, efficient manner.
    2. Know the normal structure and function of the body (as an intact organism) and of each of its
       major organ systems, across the life span.
    3. Know the molecular, biochemical, and cellular mechanisms that are important in maintaining
       the body’s homeostasis.



                                                                                                     36
   4.     Know the various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune,
         neoplastic, degenerative, and traumatic) of maladies and the way in which they operate on the
         body (pathogenesis).
   5.    Know the altered structure and function (pathology and pathophysiology) of the body and its
         major organ systems that are seen in various diseases and conditions.
   6.    Understand the power of the scientific method in establishing the causation of disease and of
         the efficacy of traditional and nontraditional therapies.
   7.    Know the bio-psychosocial determinants of health and illness and of the economic,
         psychological, social, and cultural factors that contribute to the development of maladies or,
         conversely, the promotion of health.
   8.    Know the epidemiology of common health problems and the systematic approaches useful in
         reducing the incidence and prevalence of those actions.
   9.    Know the principles of pharmacology, therapeutics, and therapeutic decision-making.
   10.   Know the principles of bioethics in the practice of medicine.
   11.   Know the natural history, clinical presentation, diagnostic finding, treatment, management
         strategies and prognosis for common medical problems
   12.   Know the scientific principles underlying laboratory tests, radiological and other investigative
         studies.


III. Practice-Based Learning and Improvement

Students must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices. These relate to the areas of lifelong
learning, critical thinking, evidence based practice, quality improvement and informatics, Students are
expected to:

         1. Analyze clinical experience and perform improvement activities using a systematic
            methodology.
         2. Consider problems as opportunities for change or for the advancement of knowledge.
         3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’
            health problems.
         4. Demonstrate knowledge of study designs and statistical methods and the ability to apply
            this knowledge to the appraisal of clinical studies.
         5. Use information technology to manage information, access on-line medical information; and
            support their own education.
         6. Demonstrate effective presentation/teaching skills.
         7. Demonstrate a commitment to the teaching and learning of students and other health care
            professionals.
         8. Continuously and progressively develop abilities to utilize clinical and scientific information
            in determining priorities and making patient care decisions.




                                                                                                        37
IV. Practice-Based Learning and Improvement

Students must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their patients families, and professional associates.
Students are expected to:

   1. Demonstrate the ability to create and sustain therapeutic and ethical relationships with patients
      based on mutual respect and trust.
   2. Demonstrate the ability to use effective listening skills.
   3. Provide information using effective nonverbal, oral and writing skills with patents, families,
      colleagues and other members of the health care team.
   4. Demonstrate the ability to work effectively with others as a member or leader of a health care
      team or other professional group.


V. Professionalism

Students must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population. Students are expected to:

   1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
      society that supersedes self-interest; accountability to patients, society, and the profession; and
      a commitment to excellence and on-going professionals development.
           a. Demonstration personal integrity, honesty, and self-discipline.
           b. Demonstrate responsibility, dependability, reliability.
           c. Demonstrate ability to take responsibility for one’s own actions, including errors, and
                recognize the need for supervision and self-assessment.
           d. Project a professional image in manner, dress, grooming, and interpersonal
                relationships that is consistent with the medical profession’s contemporary standards in
                the community.
           e. Act respectfully to peers, staff, faculty and patients.
           f. Be a good citizen of the community and society as demonstrated by:
                      i. Altruistic behaviors including donation of time and resources for the benefit of
                         the community.
                     ii. Involvement in community groups and other service to the community.
                    iii. Avoidance of criminal acts.
           g. Demonstrate a commitment to excellence and ongoing professional development.
           h. Mentor others in professional behavior (i.e. role model and teacher)
           i. Recognize acute and chronic personal limitations that may impact patient care and
                professional behavior. This includes medical conditions and substance abuse.
   2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
      clinical care, confidentiality of patient information, informed consent, and business practices.
   3. Recognize ethical dilemmas and need for appropriate consultation (e.g. hospital ethics
      committee).
   4. Choose effective diagnostic and therapeutic modalities based on the best evidence and patient’s
      preference.

                                                                                                      38
    5. Describe the threats to medical professionalism posed by the conflicts of interest inherent in
       various financial and organizational arrangements for the practice of medicine.
    6. Demonstrate the capacity to recognize and accept limitations of one’s knowledge and clinical
       skills.
    7. Accept that the patient is a person with important values, goals, and concerns, who lives in a
       family/community context; and that these factors have a significant impact on the disease
       process and treatment.
    8. Demonstrate tolerance and consideration for the concerns and opinions of others.
    9. Recognize the impact that characteristics such as culture, age, gender, and disability has on
       patient care, preferences/perceptions and outcomes.


VI. Systems-Based Practice

Students must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal value.
Students are expected to:

        1. Be able to operate effectively with the organization of health care delivery systems by
           understanding financing, quality of care, access and information management systems.
        2. Understand how their patient care and other professional practices affect other health care
           professionals, the health care organization, and the larger society and how these elements
           of the system affect their own practice.
        3. Know how types of medical practice and delivery systems differ from one another, including
           methods of controlling health care costs and allocating resources.
        4. Understand cost-effective health care and resource allocation that does not compromise
           quality of care.
        5. Advocate for quality patient care.
        6. Be able to navigate the patient through community resources including physician, other
           medical and non-medical community resources.
        7. Be able to access the resources that will identify community health care needs.
        8. Be able to work in interdisciplinary teams with other medical and non-medical service
           providers.




                                                                                                          39
Appendix B Personal, Professional, Ethical, Leadership Curriculum

(V-3, V-4, V-6, V-7, V-8, V-14, V-16, V-17)

Purpose

To provide a small group learning environment to allow for the educational opportunities that
would allow for the foundations of Ethics and Professionalism to be built.

Goals

  1. To teach and model the mutual support and collaboration that is critical to successful
     medical practice.
  2. To provide a safe environment where students can learn about themselves, about
     ethical and professional issues surrounding the practice of medicine and about
     interactions with others on the healthcare team.
  3. To help students feel supported during the transition into medical school and into the
     practice of medicine.
  4. To provide the opportunity to maintain a support group throughout the four years of
     medical education.
  5. To help students develop a personal mission and vision.
  6. To help students develop a sense of belonging to and responsibility towards the
     profession of medicine.
  7. To provide educational opportunities to allow the student to explore the depths and
     complexities of medical ethics and professionalism.
Methods

   1. Faculty members will be identified as facilitators:
          a. One Basic Science Faculty member per group
          b. One Clinical Faculty member per group
      The facilitators will be assigned to a randomly selected group of 8-10 students.
      Facilitators will meet prior to orientation for facilitator’s orientation.

   2. Medical Student Orientation
         a. Students will be assigned to two faculty members for the duration of the 4 years
             with particular emphasis on the first two years of medical education.
         b. Team building activities will occur to allow for cohesion of the group and the
             foundations of Ethics and Professionalism will be covered in one session during
             orientation.
   3. Year one
         a. Brief large group sessions will be provided to allow for an overview of topics
             related to ethics and professionalism.
         b. The students and facilitators will then break into their small groups for case
             studies on the day’s topic.
                                                                                          40
4. Year Two
      a. Brief large group sessions will be provided to allow for an overview of topics
          related to ethics and professionalism.
      b. The students and facilitators will then break into their small groups for case
          studies on the day’s topic.




                                                                                    41
Members of the Professionalism Subcommittee of the CIC

                                     Alice House, MD – Chair

                                       Zoeb Bootwala M-IV

                                       Jerry Daniel, PhD, JD

                                        William Ellien M-III

                                     Richard Elliott< MD, PhD

                                     Maribeth Hamrick M-III

                                           Anna Krampl

                                         Barry Prior, PhD

                                       Allison Scheetz, MD




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