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Professionalism: A
New Curriculum

Dr. Debora H. Silva
Dr. Gladys Gonzalez-Navarrete
UPR School of Medicine

 There are new challenges to the practice
  of medicine
     Advances in technology
     Disparities in health care
     Limited resources
     Market forces
     Conflict of interests
     Society perceives a loss of professionalism
      in physicians
 There is a new trend to teach
  professionalism in medical schools
 The AAMC Medical Schools Objective
  Project defines the professional
  attributes a student should possess at
  the time of graduation
 The ACGME defines professionalism as
  one of the core competencies a resident
  should possess
 LCME ED-23:
     “A medical school must teach medical
      ethics and human values, and require its
      students to exhibit scrupulous ethical
      principles in caring for patients, and in
      relating to patients’ families and to others
      involved in patient care”
        Scrupulous   ethical principles: honesty,
         integrity, confidentiality, respect
 ABIM Foundation, ACP-ASIM
 Foundation and European Federation of
 Internal Medicine created: “A Physician
 Charter: Medical Professionalism in the
 New Millennium”

 Fundamental Principles
     Primacy of patient welfare
     Patient autonomy
     Social justice
 Set of Professional Responsibilities
     Commitment to professional competence
     Commitment to honesty with patients
     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
   Commitment to scientific knowledge
   Commitment to maintaining trust by
    managing conflicts of interest
   Commitment to professional
Curriculum Development

 The UPR AOA Chapter undertook as
  their special project the development of
  a Professionalism Curriculum
 The overall goal of the curriculum is to
  introduce the basic aspects of
  professionalism throughout the four
  years of medical school and influence
  students’ attitudes and behaviors
Phase I: 2003-2004

 First Year Medical Students (Class of
  2007) during the Introduction to Clinical
  Skills Course
 Teaching Strategies:
    Anonymous survey based on vignettes of
     common ethical issues
    Grand Round: Charter on Medical
       Professionalism, Film “The Choice is
       Yours”, reflection and discussion period
      Small group discussions based on
       vignettes illustrating various principles of
       professional conduct
      Repetition of initial survey
 Evaluation Strategies:
     Comparison of anonymous survey results
     Faculty evaluation of the small group
     Student evaluation of the teaching
 Results of Phase I:
     Students found the curriculum appropriate
      and necessary
     Faculty found the students interested,
      motivated and well informed
 Changes since 2003:
     Introductory lecture on Professionalism
     Evaluation of professional attitudes and
      behavior during clinical activities
Phase II: 2004-2005

 Second year medical students (class of
  2007) during the Integration Seminar
  Workshop Series
 Teaching Strategies:
     PBL case work on Conflicts of Interest or
      ethical issues
     Two sessions for discussion
 Evaluation Strategies
   Student evaluation of exercise
   Faculty evaluation of exercise

 Results
      Agreement by students on the need to
       cover this subject in the curriculum
      Evaluated as excellent teaching strategies
       by students
      Faculty reports lively and in-depth
       participation from the students
Phase III: 2005-2006

 Third year medical students (Class of
  2007) during the Internal Medicine
 Teaching Strategies:
     Professionalism Workshop
        Live interview of 3 patients by an attending
        Small group discussion of the interviews with
         key questions to guide the discussion
        Development of a summary of aspects
         discussed with a list of professionalism issues
         and recommendations on how to manage the
 Evaluation Strategies
     Student evaluation of the exercises
        Only one group has evaluated the activity up
         to now
        Students evaluated the activity as excellent

     Faculty evaluation of the exercises
     Evaluation of professional attitudes
      incorporated into the student’s evaluations
        Case   presentation, rounds, etc
Faculty Development

Activities for faculty development in
  teaching and modeling professionalism
  are being developed
 Faculty is being trained to teach
  professionalism using a PBL approach
  and a small group session approach

 A curriculum on professionalism can be
  introduced within the medical school
 A step-wise manner and ownership by a
  course or clerkship seems to help in the
  implementation process
 Continuum through the four years
  reinforces the objectives

 Development of fourth year medical
  students activities
 Exit evaluation of the project
 We hope these interventions will result in
  enhanced awareness and compliance
  with professional behavior.

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