The report summarizes a convening of the 19 grantees who received funding from the national initiative, Educating and Training to Professionalism, co-sponsored by the Macy Foundation. Watch what some of the grantees have to say about medical professionalism.
Working in today’s complex health care environment places a complicated set of stressors on physicians and other health care professionals. They want to put their patients’ needs first, but must also manage rapidly increasing demands on their time, energy, abilities, and mental health. Preparing students for these challenges requires our nation’s health professions schools and clinical learning environments to adopt a much more deliberate and integrated approach to teaching professionalism. According to the ABIM (American Board of Internal Medicine) Foundation, “medical professionalism is the daily expression of the desire to help people and society as a whole by providing quality health care to those in need.” It also is a concept that is evolving and expanding—“from autonomy to accountability, from expert opinion to evidence-based medicine, from individual responsibility to teamwork and shared responsibility.” Teaching professionalism instills in learners a strong ethical foundation that helps them balance competing needs and resolve moral dilemmas while delivering high-quality, patient-centered health care.
In 2011, the Institute on Medicine as a Profession (IMAP) and the Josiah Macy Jr. Foundation jointly launched a pilot program to develop innovative approaches to teaching professionalism to the next generation of physicians. The successful pilot effort became a four-year national grant program: Educating and Training to Professionalism. Between 2011–2014, two-year grants of $50,000 (with institutional matching) were awarded to 19 academic health centers across the country to establish novel programs to teach professionalism at the undergraduate and graduate levels.
The grant program defined professionalism in teaching and learning environments as a set of ethical behaviors and actions that medical students and residents can observe, model, and practice—in their interactions with patients, with their health care team members, and within their larger health system communities. The grant program was intentionally permissive and did not specify which aspects of professionalism were to be emphasized. The following areas were suggested as illustrative of topics to be considered.
- Putting Patient Interests First: Physicians must not allow their own interests or those of their institutions to take precedence over the well-being of their patients. Conflicts of interest must be resolved in favor of patients.
- Enhancing Social Justice: Physicians should work to eliminate inequities in health care delivery, providing patient care that is informed by the social determinants of health, and that addresses health disparities across all population groups.
- Promoting a Just Distribution of Finite Resources: Physicians are required to provide health care that is evidence-based and cost-effective. Physicians’ professional responsibility demands scrupulous avoidance of unnecessary tests and procedures so as to protect patients from harm and preserve health care resources.
- Valuing Interprofessional Teamwork and Collaboration: Physicians are responsible for participating as equal members of high-functioning health care teams and for recognizing and supporting the vital roles and contributions of their team members.
- Encouraging Physician Advocacy: Physicians should understand the need for advocacy not only for their patients but also for the common good. They should be taught the skills necessary to fulfill this responsibility.
The 19 institutions pursued a variety of innovative, faculty-directed efforts to teach professionalism, with 15 targeted to residents, 11 to students, and 11 to faculty, and with most targeting at least two of these three groups. Three of the projects included an interprofessional component.
Today, several years after the initial IMAP/Macy pilot program, professionalism remains a crucial component of medical education—and of health professions education in general. Most of the 19 grant programs are still in operation in some form, having been integrated into their institutional curricula and/or residency programming.
To more widely disseminate what we learned through these efforts and what they achieved in their institutions, IMAP and Macy brought together representatives from the grant-supported programs to share their work and discuss next steps for professionalism education. The conference, Educating and Training to Professionalism: A Convening of Grantees, was held over two days in September 2017 at Columbia University in New York.
This monograph captures the important themes of the meeting and includes highlights from the keynote presentations as well as the plenary and small-group discussions. It also includes a conclusion from IMAP President David Rothman, PhD, and Macy Foundation President George Thibault, MD, identifying critical next steps and calling on institutions across the country to further advance the teaching of professionalism. Detailed summaries of the grant efforts also are included in this monograph. Finally, biographies of meeting participants can be found at the end of this monograph. It is a testament to the value and success of their efforts that leaders from 18 of 19 grant programs attended the meeting several years after their funding expired.