Competency-based professionalism in anesthesiology: Continuing Professional Development

Jocelyne McKenna 0 1 H. David Rosen 0 1 0 H. D. Rosen, MD Departments of Anesthesiology and Cardiology, Harvard Medical School, Children's Hospital Boston , Boston, MA, USA 1 J. McKenna, MD (&) Department of Anesthesiology , The Ottawa Hospital, University of Ottawa , 501 Smyth Road, Ottawa, ON, Canada Purpose Fulfilling the current societal expectations for professionalism in medicine requires a clear understanding of the specific skills, attitudes, and behaviours expected of practitioners. This Continuing Professional Development (CPD) module discusses professionalism as it relates to the practice of anesthesiology. Principal findings While many of the attributes of the professional are generic, performance expectations must be interpreted in a specialty-specific context. Anesthesiologists face challenges to their professionalism in the timeconstrained, highly technical and stressful operating room environment. Ongoing shifts in the models of health care delivery require the adaptation of anesthesiology practice to meet changing demands. Consequently, anesthesiologists' practice environment has extended into preoperative assessment units, acute pain services, and perioperative medicine. Application of principles of biomedical ethics, understanding of medico-legal and regulatory aspects of practice, and attention to personal health and career sustainability are intrinsic aspects of professional practice. More recently, focus on adverse event management and continuous quality improvement has created the need for specific skill sets, which must be included in training and continuing professional development programs. The medical education literature suggests teaching and evaluation methods suited to the development of competence in all aspects of professionalism. Finally, professionalism requires the availability of remediation programs for learners and practitioners in difficulty. Conclusion The attitudes, skills, and behaviours that define professionalism in anesthesiology must be taught and evaluated to establish a basic level of competence by the completion of specialty training. Throughout their careers, anesthesiologists must continue their professional development to meet current and future societal expectations and shifting norms of health care delivery. 1. Define professionalism and its underlying competencies in relation to the current practice of anesthesiology in Canada. 2. Understand why professionalism needs to be explicitly taught and evaluated. 3. Become familiar with teaching and evaluation strategies in anesthesiology. 4. Explain the challenges to remediating unprofessional conduct, and learn strategies that may be useful in trainees or practitioners at any stage of their career. Physicians everywhere are increasingly facing challenges to their professionalism. Some of these have arisen in the public forum, where confidence in institutions, such as the clergy, the police, and teachers, has been adversely affected by public reports of negligence, abuse of power, and cases of criminal activity.A Media reports of conflicts of interest and fraud in medical research1 and reports of sexual and other forms of abuse by physicians continue to pose a serious threat to the public trust the medical profession has enjoyed for centuries. Practicing physicians in all specialties have become keenly aware of the potential consequences of lapses in professional behaviour.2 The medical profession, through its legal and regulatory bodies, has sought to counter the decline in public confidence by emphasizing the importance of professionalism in its undergraduate and postgraduate programs. Maintaining and, in some cases, restoring the publics trust in physicians is seen by some as one of the most pressing challenges facing the medical profession in the past century.3 Definition of professionalism Despite a large number of publications on medical professionalism in the past two decades, it is difficult to find a simple definition that encompasses all aspects of the term.4 Most definitions include the concepts of clinical competence, ethical practice, and adherence to the medico-legal and regulatory aspects of practice. While essential, these concepts are not however sufficient for professionalism.5 Values, such as altruism, excellence, humanism, and accountability, are required and are at the core of professional behaviour. While individual values may at times come into conflict, the ability to resolve those conflicts is also a requirement of medical professionalism. A schematic definition of professionalism by Stern et al.5 illustrates these interrelated concepts (Fig. 1). An alternative definition by Blackmer6 from a white paper entitled Professionalism and the Medical Association reads as follows, Medical professionalism describes the skills, attitudes, values and behaviours common to those undertaking the practice of medicine. It includes concepts such as the maintenance of competence for a unique body of knowledge and skill set, personal integrity, altruism, adherence to ethical codes of conduct, accountability, a dedication to self-regulation, and the exercise of discretionary judgment. Professionalism is also the moral understanding among medical practitioners that gives reality to what is commonly referred to as the social contract between medicine and society. This contract in return A On December 28, 2010, a Montreal Gazette headline read: Trust in professionals is on the wane: poll. The author describes a decline in the level of trust that patients have in their doctors and other professionals. Physicians had one of the largest declines in trust levels of all professions. This explains the serious attention this declining trust has been under from medical schools, specialty societies, and regulating bodies. grants the medical profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Learning medical professionalism Learning professionalism is a developmental process that begins in medical school and continues throughout residency and the years of practice. In Canada, the Royal College of Physicians and Surgeons of Canada (RCPSC) has defined the specific skills and attitudes that must be present for competence in the role of professional.7 These in turn require translation into specialty-specific goals and objectives of training. The CanMEDs professional role is defined as having four main subsets or areas of competence (Fig. 2): 1) Professional conduct, which includes personal attributes, interpersonal behaviours, and adverse event management; 2) Ethical practice, which refers to the generic principles of biomedical ethics as well as specialty-specific ethical practice; 3) Legal and regulatory framework of practice; and 4) Physician health. Each of these four items will be discussed in turn. Professional conduct (Table 1) Personal values, such as altruism, empathy, (...truncated)