Professionalism Initiative
The medical profession has traditionally enjoyed a highly respected position in society. This position is threatened not only by the overt unprofessional behavior and attitudes of some individuals, but also by ongoing changes in the health care system.
What is Professionalism?
Rapid advances in medical knowledge and technology are putting increased pressure on medical professionals to process huge quantities of information, with time-consuming but essential requirements for continuous updating of knowledge and skills. Changes in the health care system have created a competitive environment with more stress factors. These new demands and the expectations of the public and the medical community have altered the image of the medical professional. Professionalism, once so ingrained in that image, must be preserved and enhanced.
With the external pressures imposed on it, the medical profession is facing a critical moment in time. Its ability to retain its leadership role in society depends largely on its willingness to abide by a standard of excellence and behavior. Individuals must maintain a commitment to professional ethics and high standards of moral and ethical behavior. As members of the academic medical community, professionals are obligated to set an example for both their students and community peers.
While knowledge and technical skills are crucial in medicine and science, the manner in which they are used is equally important. All medical professionals must strive to retain those humanistic qualities that constitute the essence of professionalism. These qualities apply to all aspects of the professional's life, including the relationships between medical professionals, between specialties and between professional organizations.
This is the essence of professionalism. The best interest of others including patients, colleagues, mentors and trainees, rather than self-interest, is the rule.
Medical professionals are accountable to their patients, colleagues and society as a whole for the health needs of the public and the advancement of science. They are accountable to their profession for adhering to medicine's time-honored ethical principles.
This is a conscientious effort to exceed expectations and to make a commitment to life-long learning. Commitment to excellence is an acknowledged goal for all medical professionals and should begin on the first day of medical school.
The free acceptance of a commitment to service. This commitment entails being available and responsive when needed, accepting inconvenience to meet the needs of patients, advocating the best possible care regardless of ability to pay, seeking active roles in teaching and professional organizations, and volunteering skills and expertise for the welfare of the community.
The consistent regard for the highest standards of behavior and the refusal to violate personal and professional codes. They imply being fair and truthful, keeping one's word and meeting commitments. They also require recognition of possible conflicts of interest and avoidance of relationships that allow personal gain to supersede the best interest of the profession.
Including patients, their families and other professional colleagues, this is the essence of humanism, which is both central to professionalism and fundamental to enhancing collegiality among medical professionals.
Essential to assure the highest quality of medical care and scientific progress and stay abreast with the constant changes in scientific information, technology and tools. This commitment must be accepted from the very beginning and must be honored throughout one's life as a physician and scientist.
Abuse of power can take many forms: not allowing patients to contribute to decision-making in their own care; allowing financial and academic competitiveness to affect judgment, including the honest evaluation of peers and trainees; using the work of junior colleagues to enhance one's academic career; deliberately hindering the academic development of junior colleagues; the unwarranted undermining of junior colleagues; medical student abuse and abusive behavior toward colleagues. The respect and trust of patients and professional colleagues are to be cherished, not abused.
The medical profession has a particular responsibility to ensure an environment where all colleagues can enjoy equal respect and advance to their full potential, irrespective of disability, ethnicity, gender, race or religion. Inequities that impair the professional and personal development of any individual cannot be allowed. Even seemingly minor events, such as ethnic or gender-related jokes, may create a hostile environment which negates the basic principles of humanism in the medical profession. Medical student abuse is a problem formally recognized only in the early 1980s. It has been well described in the medical literature. Such behavior, whether directed toward medical students or professional colleagues, is unacceptable at the University of Kansas School of Medicine.
Patients trust that conversations and information obtained as part of the patient/physician relationship will be held in strictest confidence. This trust is not to be violated. Casual comments or discussions of patients in public are breaches of confidentiality and are unacceptable. Disclosures are allowed only in the course of patient care, in the patient's best interest or when disclosure is a legal requirement. Likewise, confidential communications of scientific data, manuscripts and intellectual property should not be used for personal gain or divulged publicly.
Arrogance is an offensive display of superiority and self-importance. Unfortunately, by their nature, medicine and science can foster arrogance in the medical professional. The training is long and arduous with a seemingly endless mass of knowledge, which at times feels impossible to master. Students of science are thus prone to assume an air of self-importance, having survived such an initiation. Arrogance destroys professionalism by reducing the individual's ability to think for himself or herself, making empathy for others difficult and removing the checks and balances of self-doubt.
Greed can be defined as the inappropriate aspiration of fame, power or money. Greed impairs altruism, caring, generosity and integrity and therefore negates professionalism. In order to avoid greed, it must be recognized as a potential component of professional lives, and the medical professional must constantly reevaluate his/her motives to ensure that no actions are dictated solely by personal gain.
In the context of unprofessional behavior, misrepresentation consists of lying and fraud. Lying requires a conscious effort to not tell the truth. It is not simply relating an untruth, or any erroneous statement could be construed as lying. Lying about class assignments or experiments, or misrepresenting patient-related data because of failure to complete an assignment or find the correct information, are serious breaches in professionalism, which raise the specter of overall dishonesty in the individual responsible. Fraud is a conscious misrepresentation of information with the intent to mislead. It can occur in both medical practice and research. Lying about the services performed in order to obtain reimbursement and misrepresentation of experimental data are examples of fraud.
Medical professionals who are impaired in their ability to carry out their professional obligations must relinquish their responsibilities, particularly when caring for patients. Impaired cognitive abilities and judgment due to illness are no less common among medical professionals than among the public at large. While severe impairment may be easy to recognize, marginal impairment may not be readily detectable and doubt may exist about whether it is even present. Reluctance to draw attention to an impaired or potentially impaired colleague is a significant problem associated with this aspect of medical professionalism. Rationalizations that inhibit prompt and appropriate action are common, but inaction in dealing with an impaired colleague is a failure of professional obligation.
Professional Development Curriculum
Our team has developed curriculum to support the school's professionalism initiatives.
Academic Environment Professionalism
The environment in which the training and education of medical professionals takes place serves in many ways as the incubator of professionalism. Standards for professional and ethical conduct are beginning to be addressed within the formal curriculum of medical schools but must be reenforced by example of the faculty and staff. Factors which aid and obstruct professionalism coexist to a greater degree in this environment.
Positive factors - The profession of medicine, and academic medicine in particular, is recognized by society for its service to societal goals, its commitment to healing the sick and the advancement of knowledge. Professionalism is enhanced by the high standards of the educational environment and its dedication to collegiality, support of formal mentoring programs and formal recognition of faculty, housestaff and student role models.
Negative factors - The increasing expectations in the face of decreasing resources confronting medical professionals, particularly in the academic environment, can threaten professionalism. The list of challenges to professionalism is extensive, but most prominent are stress and overwork; chronic fatigue and sleep deprivation; lack of confidence, self-esteem and experience due to inadequate supervision; tension with other professionals; arrogant and demeaning behavior; exposure to health risks; decreasing revenues despite increasing workloads, and, not least, family obligations. The academic environment may never be able to eliminate all of these barriers, but by their recognition, efforts may be successful in circumventing them and their potential damage.
Descriptors of Unprofessionalism
Medical professionals, by definition, are expected to demonstrate professionalism. The following descriptors serve only as a baseline to identify behavior which is unacceptable for meeting the standards of professionalism inherent in being a medical professional.
Unmet professional responsibility - This includes requiring continual reminders about responsibilities to patients, to the institution and to other health care professionals, unreliability in completing tasks, or misrepresenting or falsifying actions and/or information. Accepting but not fulfilling responsibilities on committees, teaching and mentoring are common examples.
Lack of effort toward self-improvement and adaptability - Medicine and academic science demand continuous personal growth and improvement. Resistance or defensiveness in accepting criticism, remaining unaware of one's own inadequacies, resisting changes, not accepting responsibility for errors or failure, being overly critical, being verbally abusive during times of stress and displaying arrogance are reflections of a poor professional attitude.
Poor interactions with patients and families - A lack of empathy, insensitivity to patients' needs, feelings and wishes or to those of the family, lacking rapport with patients and families, inadequate commitment to honoring the wishes of the patient are symptoms of poor professionalism, not mitigated by skills and good outcomes.
Inappropriate relationships with health care professionals - The inability to function within a team, lacking sensitivity to the needs, feelings and wishes of colleagues, harassment and discrimination are major hindrances to creating a healthy and satisfying professional environment.
Professionalism Entities and Activities
The KU School of Medicine Professionalism Initiative includes many entities and activities:
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The Academic Societies and several ceremonial components of the medical school have been established to remind students and faculty of the rewards and obligations of the medical professional. These include the White Coat Ceremony for incoming first year medical students, the Transition Ceremony for third year students beginning their clinical rotations and the traditional Hooding Ceremony where new doctors are vested with the traditions and responsibilities of the profession, including a recitation of the Hippocratic oath.
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Teaching and practicing professionalism includes a frank discussion of professional issues during daily activities as well as workshops and formal lectures on the background and significance of professionalism, including its evolution in response to changes in society.
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The Rainbow Award, given by the students each year to a faculty member who best represents the essence of Professionalism in Medicine.
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The Deborah E. Powell, M.D., Pride in the Profession Award, is awarded each year at the University of Kansas Medical Alumni Association's Graduation Celebration.
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The Advisory Group on Professionalism (AGoP) is an informal group of faculty, hospital administrators, residents and medical students specifically trained and available to educate members of the KU Medical Center community about professionalism and to hear and facilitate resolution of issues or concerns about professionalism in a non-threatening manner. Formal grievance channels are available throughout the medical center system, but are often not the optimal route and individuals may fear following those channels for a variety of reasons. The AGoP is intended to assist with these issues in an informal, collegial manner, with confidentiality and respect for all parties involved. Any member of this group may be contacted individually.
White Coat Ceremony
All entering medical students at the University of Kansas School of Medicine take an oath of commitment during the "White Coat Ceremony" at the onset of Medical School, the beginning of their medical careers. This oath summarizes the essence of professionalism: all medical professionals are encouraged to honor the guidelines set forth in this document.
White Coat Ceremony Oath of Commitment
As I begin my training as a physician at the University of Kansas School of Medicine, I pledge the following:
I promise to earn the trust and respect of my teachers and to return them in kind,
for only through mutual trust and respect can we learn the skills required of a physician.
I will accept responsibility for those medical duties that I feel prepared for;
I will hold back when I am not prepared; and I will seek the experience that I need to prepare myself.
I will strive to preserve the dignity, the humanity and the privacy of all my patients,
and through my openness and kindness I will seek to earn their trust in turn.
I will treat my patients and my colleagues as my fellow beings and never discriminate against them for their differences; and I will ask that they do the same for me.
I will value the knowledge, and the wisdom of the physicians who have preceded me;
I will add to this legacy what I am able, and I will pass it on to those who come after me.
As my skills and my knowledge grow so too will my awareness of my limitations and my errors; I will strive to recognize and understand my weaknesses; And I promise never to put an end to my studying and learning that I might improve myself every day of my practice, in all the years to come.
Honor Book
In 2004, on the occasion of the admission of the 100th class to the School of Medicine, the Honor Council introduced the Book of Honor. Each first-year student signed the book as a celebration of the school's trusting community and its foundation in the Honor Code. The book stands as a testament to the special environment we take part in, an environment of integrity and character grounded in the Honor Code. The signing of the Honor Book serves as a symbol and a celebration of the Honor Code, and as an affirmation of one's belief in a community guided by the principles of professionalism.
Knowledge is Healing Program
The Knowledge is Healing Program honors donors to the KU Medical Center Willed Body Program. Each fall, students and School of Medicine faculty participate and express their appreciation and gratitude to the donor families.
Transition Ceremony
The Transition Ceremony at the University of Kansas School of Medicine is a rite of passage which signifies that students have attained the knowledge, skills, attitudes and behaviors required to begin to care for patients. The Transition Ceremony is held as Medical Students complete their second year of studies and prepares them to begin their role as student clinicians. Making the transition from the first two pre-clinical years of medical school to the clinical rotations is a critical transition in a medical student's life. It is a landmark in the educational career of each student and celebrates the students' readiness to use their basic science and clinical science skills in the care of patients on their clerkships. The event celebrates the success of our students, alleviates some of the anxiety associated with the transition from an emphasis on classroom learning to the clinical rotations and reviews the critical issues of professionalism, HIPAA, confidentiality and the importance of humanism and compassion inpatient care. An important part of the event is discussions with fourth-year students in which senior students mentor entering third-year students and provide practical information on how to thrive on patient care units and how to provide optimal care to patients.
Pride in the Profession Award
The Pride in the Profession Award was established in honor of Dean Deborah Powell, M.D., who served as Executive Dean of the School of Medicine and Vice Chancellor for Clinical Affairs from 1997-2002. During her tenure, Dean Powell instituted programs of professionalism for students and faculty. She established the White Coat Ceremony to symbolize the students' entry into the medical profession and supported the establishment of the Academic Societies as part of her vision of the mentoring of students by practicing physicians. She continues to work with students and serves as an inspiration to future generations of students. The Pride in the Profession Award is presented annually to the senior medical student who most appropriately characterizes the qualities of professionalism in medicine envisioned by Dean Powell during her tenure at KU Medical Center. The recipient receives a plaque, a $500 award and their name is added to a master plaque displayed in the School of Medicine.
Previous Pride in the Profession Recipients
2021- Brynn Wright
2020- Emily Lenherr
2019- Mathew L. Moreno
2018- Tawana Marie Coates, M.D.
2017- Sarah Carlson, M.D.
2016- Jeffrey Ogar,M.D.
2015 - Matthew Blue, M.D.
2014- Lucinda Gruber, M.D.
2013- Laddy Maisonet, M.D.
2012- Sheldon Leslie, M.D.
2011- Courtney Huhn, M.D.
2010- Patrick Stiles, M.D.
2009- David Biller, M.D.
2008- Blair Thedinger, M.D.
2007- Kurt McCullough, M.D.
2006- Mayra Sanchez, M.D.
2005- Jennifer Scott-Koontz, M.D.
2004- Matthew Weiss, M.D.