The development of the "person" cannot be completely separated from the development of the "professional" for students who choose to enter medical school so as to become a practitioner of medicine. The difference is that development of the person begins before the development of the professional person. The Admissions Committee of the School of Medicine seeks to admit students whose personal values, characteristics and intelligence forms an adequate scaffold upon which to build the essential attributes of a Medical Doctor.
The American Board of Internal Medicine (ABIM) has developed a definition of professionalism that identifies the essential attributes of physicians who wish to practice internal medicine. The personal attributes contained in the ABIM definition include:
The ABIM states that these attributes are components of clinical competence along with the knowledge and clinical skills that promote the integrity of internal medicine (Project Professionalism, Page 5).
Anderson and Obenshain (Acad. Med. 69(1994): 323-331.) write that the practice of medicine continues to be based upon an old bag of virtues that contains compassion, dedication, honesty, integrity, courage, wisdom, and self sacrifice, and that these values are common to the world’s traditional moral systems. Moral relativism and selfishness are not present in the "old bag of virtues". Anderson and Obenshain (Ibid.) maintain that it would be unconscionable to permit students to graduate ignorant of the core moral values that the practice of medicine requires.
It is difficult to imagine physicians who practice the above listed attributes and values in professional life, but not in personal interactions with friends, family, and other people. Congruence between professional and personal values is essential. Otherwise the plot in Dr. Jeckel and Mr. Hyde may find expression in real life.
The ABIM also states that "since all of the attributes of professionalism cannot be tested on a written or oral examinations--patterns of behavior as observed throughout the continuum of training and within the educational environment--play an important role in making determinations (of professionalism)". The ABIM has therefore, developed descriptors that serve to identify behavior that is unacceptable for meeting the standards of professionalism (Project Professionalism, Pages 21, 29). The list that follows contains descriptors of "unprofessionalism" ( Mr. Hyde characteristics).
The professional and unprofessional values and attributes described above can serve as self evaluation tools to measure professional and personal growth as each of medical student passes through medical school, residency and into the practice of medicine. What follows describes some skills that will assist in that growth.
GENERAL: Life management skills, for the purposes of this section, include stress management, time management, information management, financial management, personal health management, and crisis management. Personal planning and adeptness at managing each of these issues will increase the serenity and reduce the stressors within a busy, productive life.Note that "Life Environment" is the buffer for the learning reaction. A managed life environment is important for maintenance of consistency so that learning can progress with the least amount of interference from the numerous stressors experienced by medical student. High levels of stress (distress) are not conducive to effective functioning in academic, professional, or personal areas of life. The application of life management skills will reduce the amount of distress that can occur in any human life.
Cross-linked web sites chosen to broaden understanding of the skill will follow brief discussions of each skill.
Every human on the earth will experience stress, even medical students and physicians--it is a common denominator in life. Some stress is good stress (eustress) that is helpful and assists the drive toward achievement and success. Negative stress (distress) affects life in an adverse manner and is a common cause of ill health in our society. Individuals who ignore stress signals or who cope in a negative fashion will experience escalating symptoms of stress. The symptoms may appear as burnout, exhaustion, emotional illnesses such as depression and anxiety, and physical illnesses such as ulcers, heart attacks, hypertension, and abuse of alcohol and other drugs with all the social and professional consequences.
It is also important to understand that patients are stressed by their illness. The two brief vignettes that follow illustrate this in a humorous fashion.
Following a successful defibrillation, the patient looked up at the staff and said, "I'll tell ya, if you won't do that again, I promise I'll quit smoking".
During an endoscopy, a patient kept calling the gastroenterologist, "Captain Kirk". After the procedure, the doctor asked why he was being called the Star Trek name. "Well", explained the patient, "you have just went where no man has gone before".
These two brief vignettes describe the responses of two patients to stressful medical procedures. It does not take a deep sense of empathy to know that each was scared, uncomfortable, and dependent on the medical staff for their well being. Both handled their emotional concerns with a sense of humor. It also does not take a deep understanding to acknowledge that the medical personal were also stressed, but not in a way that affected their concentration and skill.
There are two web sites on stress management that have been linked to this section. The first is entitled Stress Management for Patient and Physician. The web site is written and maintained by a Canadian physician, Dr. David B. Posen. He writes "one of the most important things we can do for patients is teach them about stress management. Even better, we can learn these lessons ourselves and then model them for our patients". Medical school and residency provide an excellent opportunity in which to learn to manage stress since there are sufficient stressors within the rigorous educational and training programs. Dr. Bernard Vishup, in his workshops on handling stress, asks each medical student to tell him a stress that they are dealing with (Coombs, H.D., Surviving Medical School, Sage Publications, Inc.; 1998 pages 7-8). One such list included fifteen different stressors. Since reading his description of "Medicine and Stress", I have kept a list of medical students stressors that the Office of Student Affairs has dealt with over the course a month. The two lists when added contain 32 specific stressors that have caused medical students distress.
I have also found that there are multiple stressors that are antagonistic. An example would be that a stress in school is carried home to cause distress in a relationship, which, in turn, adds to the stress of the medical student. This "stress effect" is frequently experience by married medical students who are trying to balance a busy academic life with family life. This is perhaps more acute for married female medical students, especially if children are involved. The web site entitled Challenges & Choices: Stress Management--The Challenge of Balance speaks to the busy woman trying to balance work and family, but the site has useful information that can be used by both males and females.