Putting the Professionalism Charter Into Practice in GME
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Transcript of Putting the Professionalism Charter Into Practice in GME
Putting the Professionalism Charter Into Practice in GME
Harry R. Kimball, MD, MACP
IHI/ACGME Conference on Professionalism
New Orleans, Louisiana
December 1, 2003
ABIM Foundation ACP Foundation
European Federation of Internal Medicine
ABIM FoundationTroy Brennan, Project Chair
Jordan Cohen
Harry Kimball
Neil SmelserLinda Blank, Project Staff
European Federation of Internal Medicine
Gunilla Brenning
Chris Davidson
Philippe Jaeger
Alberto Malliani
Hein Muller
Daniel Sereni
Eugene SutoriusACP Foundation
Robert Copeland
Risa Lavizzo-Mourey
Walter McDonald
Special Consultants
Sylvia and Richard Cruess
Jaime Merino
Project Members
Questions
• Why do we need a charter on medical professionalism today?
• Can the charter make a difference to practicing physicians, residents and medical students, and to patients?
• How will its impact and effectiveness be measured?
THE PHYSICIAN CHARTERAnnals of Internal Medicine, The Lancet, February 2002
Three Fundamental Principles
• Primacy of Patient Welfare
• Patient Autonomy
• Social Justice
THE PHYSICIAN CHARTER
A Set of Responsibilities and Commitments to:
1. Professional Competence2. Honesty with Patients3. Patient Confidentiality4. Maintaining Appropriate Relations With Patients5. Improving Quality Care6. Improving Access to Care7. Distribution of Finite Resources8. Scientific Knowledge9. Maintaining Trust By Managing Conflicts of Interest10. Professional Responsibilities
• Lifelong professional development
• Maintenance of certification
Commitment to Professional Competence1
Examinations
• Impaired physicians (self-regulation)
• Patient’s right to refuse treatment (patient autonomy)
• Abuse of power (inappropriate physician-patient relationships)
• Pregnancy/HIV (confidentiality)
• Work collaboratively to:– Reduce medical error– Increase patient safety– Minimize overuse – Optimize outcomes of care
• Help develop and implement better measures of quality health care
Commitment to Improving Quality of Care5
Quality Improvement Practicum for IM Residents and Faculty
• Collaboration: ABIM Foundation, ABIM, and Alliance for Academic Internal Medicine
• Selected Residency Programs
• Preventive Cardiology Practice Improvement Module (PIM)
• Tests applicability as educational experience in quality assessment and improvement
9 Maintaining Trust by Managing Conflicts of Interest
• Recognize the existence of many opportunities to pursue private gain
• Disclose all conflicts of interest involving professional activities
• Importance of reflective practice
10 Commitment to Professional Responsibilities
• Participate in the processes of self-regulation
• Assist in establishing educational and standard-setting activities
• Accept external scrutiny of professional performance
ABIM Strategies for Evaluating Professionalism in GME
1. Examinations
2. Program Director Ratings
3. Structured Evaluations (Mini-CEX)
4. Peer and Patient Ratings
5. Professionalism Portfolios
Program Director Ratings
Annual evaluations of professionalism along with other competencies, 9 point scale
• superior
• satisfactory
• marginal
• unsatisfactory
2
Professionalism Ratings (1990-1998)
Unsatisfactory Ratings: N= 758
74% men Age: 31.647% USMG 53% IMG
Outcomes: 381 Left internal medicine 377 Completed training
269 Attempted certification193 Passed
Structured Evaluations in Professionalism:
New Generation X Mini-CEX3
Quality Improvement
Plan
Quality Improvement
Plan
ABIM Scores Report
10 Peers
25 Patients
Self-Assessment
ABIM Scores Report
10 Peers
25 Patients
Self-Assessment
Select raters; Distribute surveys; Use interactive
voice response system to complete
Patient and Peer Assessment4
Professionalism Portfolios
• show evidence of competence
• promote self-reflection and self-awareness
• stimulate self-directed learning
• foster a healthy professional lifestyle that leads to achieving long-term career goals
A promising strategy to:
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The Competent Physician
David Leach and the ACGME provide the following definition:
"The competent physician habitually incorporates three elements into daily work: evidence-based medicine, patient-centered care, and reflective
practice."
The Charter on Medical Professionalism reaffirms these elements and provides a contemporary framework for both action and realization.