ProfessionalismSyllabus2009 2010 by F67L6SS

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									                                                Syllabus
                                      Professionalism 2009-2010
                                             UMDNJ/SOM
                        E. L. Erde, Ph. D. 856-566-6246 or erdeel@umdnj.edu

       Check on Angel for the first written assignment and email your
    answers to erdeel@umdnj.edu by August 7. If on time and done
    responsibly, earn 10% of the course grade; otherwise, lose 10%.
       Also on Angel, read “Academic Context for Professionalism-I” It
    relates to the whole course.
          Bring to the first class:
       (a) This Syllabus,
       (b) The answers you emailed for the assignment posted on Angel, and
       (c) “Academic content for Professionalism-I”– this may be useful in most
    meetings.

                             Contents of This Document
     A.          Introduction                                                            Pages 1-3
     B.          Goals and Objectives                                                    Pages 3-4
     C.          Tentative Schedule                                                      Pages 5
     D.          Grading Policy                                                          Pages 5-6

                                       A. Introduction
        This first year course is about professionalism as an ethic and an ethos.1 It is part
    of a 4-year program at SOM. The course introduces many topics, some of which will
    get more attention in later courses, standardized patient (SP) encounters or clinical
    rotations. In those settings, we address classic ethical issues, such as abortion, issues
    about dying, relationships with the pharmaceutical industry, psychiatric commitment
    and incompetence, suicide, children’s rights, and medical errors.

1
  The Cambridge International Dictionary of English defines an ethic as “a system of accepted beliefs
which control behaviour [sic], especially such a system based on morals.” Thus, it includes values, rules,
and ways to enforce them. An ethos includes messages beyond the praiseworthy, forbidden, permitted, etc.
It also alludes to a group’s a spirit or culture, as well as its ethical norms.
http://dictionary.cambridge.org/define.asp?key=26403&dict=CALD Accessed 7/30/08.


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          It is important for students to know the historical background of the course. It
      started with a few leaders in medicine calling for professionalism to be part of the
      formal curriculum. This may have started as early as 1980, but the calls increased in
      the 1990s.
          The calls arose from leaders’ concern with the integrity of medicine and its
      practitioners. The concern was largely attributed to changes in how insurance
      companies would pay bills.
          At the time, medical ethics had been part of the curriculum in medical schools for
      two decades. And the two fields -- medical ethics and professionalism – do overlap
      significantly. However, medical ethics does omit or ignore much that professionalism
      includes. Medical ethics even rejects some key tenets of professionalism. Thus, those
      calling for professionalism thought that medical ethics courses did not do the
      necessary work. And it did not expose students to some important moral tenets, for
      whatever cause.
          Thus, medicine’s leaders wanted it to (re)turn to professionalism per se. They
      wanted more and different education about values and norms/rules. They thought that
      professionalism could supply those.

          As a result, an important change occurred in 1999. The organization that accredits
      residencies programs2 added professionalism to its checklist. Thus, it was a required
      competency. This led to medical schools including professionalism in their curricula.
      UMDNJ/SOM joined the movement shortly after it began. Thus, we have this course.

          The content of this course overlaps with ethics but is also different. Teaching
      methods differ somewhat as well. For professionalism is an established “ism” like
      Buddhism or Catholicism. Newcomers have to be told the values and rules in such
      contexts. By contrast, in ethics, one must choose values for oneself; one must decide
      or think through how to apply the rules and when and why to suspend them.
      However, to be competent in medical professionalism, students should know
      professionalism’s current norms. Often this takes informing.

          Here, I can switch to ethics a little. We can see that some of professionalism’s
      tenets are unethical. Others are false or based on erroneous assumptions. Thus,
      students should understand professionalism’s proper content and the proper use of it.
      For example, professionalism communicates inaccurate attitudes about lawyers who
      sue doctors. It infuses newcomers with a reflex to deny or defend against allegations
      of medical mistakes. It may inculcates the value that functioning on little sleep is
      worthy of pride and praise. It shapes many other attitudes and behaviors that are
      improper.
          To understand what proper content is, students should assess the reasons for and
      consequences of its elements. In assessing these, they should use both ideas that are
      sometimes at odds. Some are generally understood from ethics. Others are and
      values that professionalism promotes. But one must start with those that
      professionalism actually promotes. Those it gets from the tribal elders, not choose
      them on their own.
2
    It is the Accreditation Council on Graduate Medical Education (ACGME).


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           Thus, professionals will use the core values that medicine stipulates as its source.
      Thinking about proper content and proper use of it will help good people orient
      themselves in the very difficult environment of modern medicine. It will provide a
      foundation to which they can return when confused, tempted, adrift or helping a
      colleague who is misbehaving. Regrettably, it will not provide enough direction for
      the inevitable surprises that will arise from society’s demands.3 That is why we must
      hope that students will also bring some wisdom and discretion with them when they
      enter SOM. And we must hope that the negative influences in the environment do not
      stifle that wisdom and discretion.


                          B. Goals & Objectives
         GOALS: This course introduces students to a framework for two sorts of
responsibilities. One sort (goal-1) is their current responsibilities; these arise from being
in training to be a doctor. The second sort (goal-2) is future responsibilities as a doctor.
The course, then, introduces knowledge about two roles—medical student and medical
doctor. It will also include some suggestions about skills related to the roles. It also has
students assess attitudes and learn some behaviors related to these two sorts of
responsibilities. .
         An intermediate concern is, then, that students gain insight into what the School
and society expect of them as doctors-to-be. Further, they should practice assessing the
rules and their own action in the light of expected responsibilities.
         The ultimate concern is that students become morally/professionally acceptable
doctors. They must know professionalism’s rules and values. They must know how to
assess those by using medicine’s mission as the assay. They must gain a perspective on
the proper motives of practitioners. They should be able to apply the norms and rules to
cases, to conduct and to policies. Hence, professionalism as an ethic will serve as a lens
through which students appreciate the demands, strengths and weakness of medical
practice. Such perspective may clarify the moral status of changes in the framework of
practice, as they occur. Thus, long and short-term, its foci are reasons, motives and
reasoning about reasons and motives.4 It is not about reciting rules or stating values.
         Finally, this ultimate concern involves wisdom and discretion. As there cannot be
rules for every situation, this course aims to support students’ quest for insight and
judgment for handling both routine issues and unusual ones.
        Scholars of education advise that goals and objectives should be stated in
behavioral terms. Thus, they discourage an objective that is put in terms of what students
will “understand” or “appreciate.” That way one can verify whether they have been met.
However, I care about student understanding and appreciating. The middle ground is to

3
    Radio Times WHYY July 29, 2008 at: http://www.whyy.org/91FM/radiotimes.html (hour 2)
4
  See “The Academic Context of Professionalism” posted on webct for class #1 for this
course. It reviews the origins of courses in professionalism. In brief, starting in the mid
1990s, leaders in the profession and in medical education called for including it explicitly
in curricula. They rejected changes that managed care produced in patient care and in the
conduct of doctors.


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word objectives in terms of students being able to analyze cases and statements of value.
It also includes wording in terms of students being able to synthesize positions about
rules, values and cases. So below is my list of objectives. I try to comply with the
demands of education science/fashion. However, being able to list elements of the
meaning of a term or to describe or discuss a problem is only a weak indication of what
matters most: grasp, perspective, and skills of self-control.

LEARNING OBJECTIVES GOAL-1 -- at the end of this course, students will:
   1.   List students’ their major responsibilities as members of the SOM community,
   2.   List students’ their major responsibilities as doctor-members of the society,
   3.   Define peer evaluation or self-policing,
   4.   Identify adaptive skills that foster their own self-care,
   5.   Assess attitudes appropriate and inappropriate to medical students,
   6.   Assess the value of the moral image that students, schools, & institutions project,
   7.   State how medical school effects students’ morale and plan for dilemmas students
        face,

LEARNING OBJECTIVES GOAL-2 -- at the end of this course, students will:
   1.  List major elements of the meaning of “professionalism” as it relates to medicine,
   2.  Describe physicians’ duties & powers,
   3.  State some less obvious ways that duties and powers can be beneficial or abused,
   4.  Describe physicians’ conflicts of interest and strategies for managing them,
   5.  Discuss problems related to poor quality care and ways of remedying those,
   6.  Describe difficulties/dissatisfaction with doctors’ social skills; suggest remedies,
   7.  Assess the value of the moral image that physicians project,
   8.  Identify important areas requiring advocacy for patients and describe some
       effective methods for advocating,
   9. Analyze cases of doctors’ dishonesty in patient care and research.
   10. Draw appropriate doctor/patient boundaries and state reasons for them,
   11. Know the professionals’ role in self-policing,
   12. Know the mechanisms of holding doctors and institutions accountable,
   13. Recognize when colleagues need help with their health, ability to practice and
       conduct, and know about resources available for helping




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                                 C. Tentative Schedule
                                                First Term

August 5                Introduction to Professionalism,                Dr. Kruger
(Orientation)           Academic Integrity & Student
                        Behavior
August 10               Introduction to the course                      Dr. Erde
8:00 – 10:00 A.M.
August 12               History of Osteopathic Medicine I               Dr. Mason
3:00 – 5:00 P. M.
August 20               History of Osteopathic Medicine II              Dr. Thompson
3:00 – 5:00 P. M.
Sept 3                  Issues from “The list of 10”5                   Dr. Erde
3:00 – 5:00 P. M.

Some of the follow dates are likely to change.

Sept 10                 Issues from “The list of 10”                    Dr. Erde
2:00 – 4:00
Sept 17                 Issues from “The list of 10”                    Dr. Erde
3:00 – 5:00
Oct 14                  Issues from “The list of 10”                    Dr. Erde
3:00 – 5:00
Nov 16                  Issues from The list of 10”                     Dr. Erde
3:00 – 5:00

                                               Second Term
    January – April                         TBA
    April                                   Exam



                                 D. Grading Policy
    I.          This course is pass-fail. The grade is based on sections II and III below. The
                course grade covers both semesters. It is registered after the final examination
                in April 2010.
    II.         A. Per the SOM attendance policy, attendance is required. There is no
                academic credit for attendance. However, insufficient attendance will result in
                a grade of “failure.” Attendance is taken every hour whether the class meets in
                full session or small groups.

5
 The list is in “Academic Overview for the Context of Professionalism” on Angel. It was part of the
assignment for August 10.


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                   A student may not sign attendance sheets for anyone except
           himself/herself. Doing so is a form of academic dishonesty. So, too, is signing
           in and leaving early or coming late and signing as though present for the full
           time.

           B. There are two types of absence:
1. Unexcused – a total of two (2) hours absence of this type is permitted. Missing more
than that results in a grade of “failure.” There is no make-up opportunity. The only
remediation is to repeat the professionalism course next year.
2. Excused by course director (at his discretion): This can apply to no more than two (2)
hours total. They are for:
                       a) Urgent health-related problems of the student –students applying
                          for this must supply a doctor’s note on letterhead affirming the
                          time and urgency of the problem (not the cause). Regular or
                          standing doctor’s appointments would not qualify as excuses
                       b) Urgent family crises or social problems – the student must notify
                          the course director as soon as the student knows s/he will miss
                          class. Documentation about the matter may be required. The
                          course director will decide whether the request is appropriate.
Required make-up assignment for excused absences: An absence will not count as
“excused” without the student completing a makeup assignment within one week. The
course director will specify the assignment. If it is not satisfactory, the absence will not
be excused.
           C. TOTALS: Students cannot miss more than four hours of class, even if
       some absences were “excused.”
           D. SUMMARY of attendance policy: Students may miss two hours as
   “unexcused.” Students may also miss two hours as “excused,” if the conditions of
   being excused are met. The course director determines whether an absence will be
   counted as “excused.”

   III.    Graded work—two types:
                    A. Examination (80%): There will be a written examination
                             scheduled after the last class. The examination will consist
                             of multiple choice, short answer, defining key concepts,
                             and essay questions.
                                     Students who fail the examination will have will
                             have to remediate by doing required reading and writing
                             assignments during the summer. If remediation is
                             unsatisfactory, they will have to repeat the course.
                           B. Writing assignments (20%): A few short writing
                             assignments throughout both terms. These must be
                             submitted on time or they will get no credit.




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