Medical Ethics and Professionalism

Ancient Origins of Professionalism

• The Oath of Hippocrates, written in ancient Greece, outlines ethical principles for physicians.
• It emphasises patient benefit, confidentiality, and consequences for violating ethical conduct.

Professionalism in the Modern Era

• Thomas Percival's "Medical Ethics" was written in 1789 during a typhus epidemic in Manchester, highlighting the importance of professionalism in managing public health crises.
• Unprofessional behaviour can undermine patient safety.
• A national survey (US) in 2008 found that disruptive behaviour in healthcare settings led to compromised patient safety and quality of care.
• Medical error is considered the third leading cause of death in the United States (2016).
• The Bristol Heart Scandal (1990s) involved high death rates in children following heart surgery at Bristol Royal Infirmary. An inquiry revealed staff shortages, lack of leadership, an "old boy’s culture" among doctors, and a lax approach to safety. The inquiry found the medical profession failed at self-regulation.

Systematic Review of Unprofessional Behaviour

• A systematic review of 11,963 studies found 46 that met inclusion criteria, suggesting unprofessional behaviour is a significant issue in healthcare.

Role Models

• Sociologist Robert K Merton coined the term "role model" to describe individuals whose behavior, example, or success is emulated by others.
• Merton hypothesized that individuals compare themselves to groups they aspire to be a part of.

Clinical Learning Environment

• The Macy Foundation (2018) defines a clinical learning environment (CLE) as a combination of social interactions, organizational cultures, structures, and physical and virtual spaces.
• Effective CLEs balance the needs for learning and work in healthcare systems, ensuring the quality and safety of patient care, promoting the well-being of medical professionals, and supporting trainee learning.

The Oath and White Coat Ceremony

• RCSI's Oath and White Coat Ceremony symbolizes the transition for medical, pharmacy, and physiotherapy students from layperson to healthcare professional in training.
• The ceremony was conducted virtually during the Covid-19 pandemic.

Community of Practice

• A community of practice is a social network where individuals share and develop overlapping knowledge, beliefs, values, history, and experiences around a common practice.
• Caring, confidentiality, promoting patient safety, integrity, self-care, practice management, use of resources, and conflicts of interest are all elements of good practice.

Irish Medical Council Definition of Professionalism

• The Irish Medical Council defines professionalism as encompassing partnership, practice, and performance.
• Performance involves behaviours and processes that underpin good care, requiring competence, reflective practice, and acting as role models, including teaching and training.

Medical Professionalism at RCSI

• RCSI defines medical professionalism as values, behaviours, and attitudes that promote professional relationships, public trust, and patient safety.

Personal and Professional Identity (PPId)

• Professional Identity Formation is the process of internalising the characteristics, values, and norms of the medical profession, resulting in an individual thinking, acting, and feeling like a physician.

Conclusions

• Medical professionalism is crucial in upholding ethical standards, maintaining public trust, and ensuring patient safety.
• The RCSI Professional Code of Conduct is essential for students in their journey to becoming healthcare professionals.

Medical Ethics

• Defined as: The science of judging human behaviour in societies as right or wrong, good or bad.
• Key principles: Autonomy, Beneficence, Justice, Non-maleficence.

Beneficence

• Actions or rules aimed at benefitting others.
• Characterized by mercy, kindness, generosity, and charity.
• David Hume's theory: Benevolence is the central principle of human nature.
• John Stuart Mill's theory: "Greatest happiness" principle, right if it leads to beneficial consequences.
• Kant's view: Duty to be beneficent.
• Exceptional Beneficence: Beyond obligation, doing more than required.

Disruptive Behaviours

• Adversely affect team functioning.
• Linked to medical errors and patient mortality.
• Examples: Sexual Harassment, Intimidation, Bullying, Rudeness, Criticism, Demanding, and Lateness.
• Survey Findings: 77% of staff witnessed disruptive behaviour by physicians, 65% by nurses.
• High-Stress Specialties: Surgery, Obstetrics, and Cardiology are most prone.
• Overall Impact: Only 2–4% of healthcare professionals regularly engage in disruptive behaviour.

Role Models

• Defined by Robert K Merton: A person whose behaviour, example, or success is emulated.
• Merton's Hypothesis: Individuals compare themselves to those in their desired social roles.

Clinical Learning Environment

• Defined by Macy Foundation: The social interactions, organizational cultures, and physical spaces shaping learning experiences.
• Balancing Learning and Work: Learning in a clinical context is foundational, Healthcare systems require learners for service.
• Importance: Effective CLE promotes quality & safety of patient care, health & well-being of the medical workforce, and trainee learning.

Oath and White Coat Ceremony

• RCSI Ceremony: Symbolizes the transition for medical, pharmacy, and physiotherapy students from "lay-student" to "healthcare professional in training".
• Ceremony during Covid-19: Conducted virtually.

Community of Practice

• Defined: A persistent social network where individuals share and develop knowledge, beliefs, values, and experiences focused on a common practice.

IMC Guidelines for Medical Schools

• Ethical Standards and Appropriate Behaviour: Set for Irish Medical Students.
• Discipline: University Medical School handles student disciplinary procedures.
• IMC Fitness to Practise: Not applicable to students.

RCSI Code of Conduct

• Six Core Principles:
  • Prioritize patient health, well-being, care, and safety.
  • Develop professional competence and bring health gain to society.
  • Be honest, trustworthy, and respectful of others.
  • Conduct yourself in a manner that enhances service and maintains professional reputation.
  • Maintain professional knowledge and competence.
  • Be aware of Code of Conduct obligations and avoid breaches.
• Breach Handling: Behaviour failing to meet standards may be referred according to RCSI policies and regulations.

RCSI Fitness to Study Policy

• Concerns: Students receiving reasonable accommodation but failing to demonstrate required competencies or refusing supports may be referred for a review.

Medical Professionalism

• Medical Professionalism: a set of values, behaviors, and relationships that underpin public trust in doctors. It embodies the core principles of Integrity, Compassion, Altruism, Continuous Improvement, Excellence, and Working in Partnership.

Integrity

• Defined as being honest and showing consistent adherence to strong moral and ethical principles.
• Doing the right thing, even when no one is looking, even when it comes at a personal cost.

Compassion

• The feeling or emotion of being moved by the suffering or distress of another, leading to a desire for relief.
• Characterized by fellow-feeling, sympathy, pity, and taking pity.

Altruism

• A disinterested and selfless concern for the well-being of others.
• Derived from the French word "autrui," meaning "other people."

Unprofessionalism

• Not pertaining to the characteristics of a profession.
• The Joint Commission, responsible for accrediting hospitals and government health insurance schemes in the USA, defines unprofessionalism as any behavior that does not adhere to the standards of a profession.

Disruptive Behaviors

• A 2008 survey of 4530 healthcare professionals in 100 US hospitals found that 77% witnessed disruptive behavior by physicians and 65% witnessed it by nurses.
• Most common disruptive behavior: verbal abuse of staff members.
• High-stress specialties like surgery, obstetrics, and cardiology were most prone to disruptive behaviors.
• Only 2-4% of healthcare professionals regularly engage in disruptive behavior.
• Disruptive behavior is linked to adverse events and medical errors.
• Disruptive behavior is linked to patient mortality.

Student Behaviours

• Medical students exhibiting unprofessional behavior in medical school were three times more likely to undergo disciplinary action.
• Key factors contributing to disciplinary action: severe irresponsibility and diminished capacity for improvement.
• Apathy and poor initiative were also correlated with unprofessional behavior.

Resilience

• Capacity to maintain well-being and work performance under pressure.
• An Emotional Competence: can be translated into skills and behaviors acquired during training.
• A Cognitive Process: encompasses four dimensions:
  • Self-efficacy: confidence in the ability to do something.
  • Planning.
  • Self-regulation: self-control.
  • Resilience: ability to bounce back from challenges.

RCSI Definition of Resilience

• The capacity to apply knowledge and skills to deal positively with adversity.
• The ability to learn and grow from challenging situations .

Penn Resilience Programme (PRP)

• A skills program designed to support and enhance well-being.
• Not a treatment program or a substitute for mental health support.
• Draws on cognitive behavioral psychology and positive psychology.

PRP Content Overview

• Focuses on teaching nine key skills for facilitating resilient responses to challenges:
  • Optimistic mindset.
  • Thinking traps.
  • Deliberate breathing.
  • Mental cues.
  • Real-time resilience.
  • Put it in perspective.
  • Positive emotions.
  • IDEAL (maintaining relationships during difficult conversations).
  • Active constructive responding.

PRP Content Delivery in THEP2

• PRP shown to have maximum effect when sustained over time.
• Year 1:
  • Module: Intro to Resilience & Well-Being (90 minutes).
  • Skill 1: Optimistic Mindset (120 minutes).
  • Skill 2: Thinking Traps (120 minutes).

The Importance of Resilience

• Resilience is essential for staying positive and thriving in challenging situations.

Medical Leadership Competency Framework

• Developed by the Academy of Medical Royal Colleges & NHS Institute for Innovation and Improvement for use in medical curricula.
• Essential Leadership Competencies for Doctors:
  • Shared Leadership.
  • "Followership": participation allows others to lead.
  • Strong Values: patient-centered, not provider priorities.

Reflective Practice: Core Skill in PPId Assessment

• A cognitive process that helps gain insights, rethink practice, learn from experiences, and cope with similar situations in the future.
• "What? So what? Now what?" is a framework for reflective practice.

Explore the historical and modern perspectives on medical professionalism, beginning with the Oath of Hippocrates and extending to contemporary issues in healthcare. This quiz examines significant events and principles that emphasize the critical nature of ethical conduct in medicine and its impact on patient safety.