Professionalism: identifying current themes

Surdyk, Patricia M.; Lynch, Deirdre C.; Leach, David C.

doi:10.1097/00001503-200312000-00005

Cited by 24 publications

(14 citation statements)

References 31 publications

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“…It is uniformly agreed that the patient's welfare always comes first; in ACGME terms, "patients have a right to expect an alert, responsible and responsive physician able to deliver effective and appropriate care." 10,11 The 80-hour workweek was intended to improve the quality and safety of patient care while allowing increased time for independent study and academic pursuits, simultaneously improving patient care and neurosurgical training. To realize this goal, most programs have had to reinvent their organizational structure, frequently relying on a handoffs approach, which in and of itself could increase the chance for clinical errors.…”

Section: Discussionmentioning

confidence: 99%

“…Work in nonmedical arenas (for example, commercial flight and interstate trucking) had documented how sleep deprivation slows psychomotor integration and impairs decision making. 11 Moreover, there was a growing recognition that much of the resident's work was not so much educational as it was scut work imposed by a healthcare system taking advantage of trainees as an inexpensive labor pool. In Europe, there was already a well-established limit on resident duty hours, largely emanating from concerns about labor laws rather than sleep deprivation and the potential for medical errors.…”

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confidence: 99%

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Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity

Jagannathan¹,

Vates

Pouratian³

et al. 2009

JNS

139

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Object. Recently, the Institute of Medicine examined resident duty hours and their impact on patient safety. Experts have suggested that reducing resident work hours to 56 hours per week would further decrease medical errors. Although some reports have indicated that cutbacks in resident duty hours reduce errors and make resident life safer, few authors have specifically analyzed the effect of the Accreditation Council for Graduate Medical Education (ACGME) duty-hour limits on neurosurgical resident education and the perceived quality of training. The authors have evaluated multiple objective surrogate markers of resident performance and quality of training to determine the impact of the 80-hour workweek.Methods. The United States Medical Licensing Examination (USMLE)Step 1 data on neurosurgical applicants entering ACGME-accredited programs between 1998 and 2007 (before and after the implementation of the work-hour rules) were obtained from the Society of Neurological Surgeons. The American Board of Neurological Surgery (ABNS) written examination scores for this group of residents were also acquired. Resident registration for and presentations at the American Association of Neurological Surgeons (AANS) annual meetings between 2002 and 2007 were examined as a measure of resident academic productivity. As a case example, the authors analyzed the distribution of resident training hours in the University of Virginia (UVA) neurosurgical training program before and after the institution of the 80-hour workweek. Finally, program directors and chief residents in ACGME-accredited programs were surveyed regarding the effects of the 80-hour workweek on patient care, resident training, surgical experience, patient safety, and patient access to quality care. Respondents were also queried about their perceptions of a 56-hour workweek.Results. Despite stable mean USMLE Step 1 scores for matched applicants to neurosurgery programs between 2000 and 2008, ABNS written examination scores for residents taking the exam for self-assessment decreased from 310 in 2002 to 259 in 2006 (16% decrease, p < 0.05). The mean scores for applicants completing the written examination for credit also did not change significantly during this period. Although there was an increase in the number of resident registrations to the AANS meetings, the number of abstracts presented by residents decreased from 345 in 2002 to 318 in 2007 (7% decrease, p < 0.05). An analysis of the UVA experience suggested that the 80-hour workweek leads to a notable increase in on-call duty hours with a profound decrease in the number of hours spent in conference and the operating room. Survey responses were obtained from 110 program directors (78% response rate) and 122 chief residents (76% response rate). Most chief residents and program directors believed the 80-hour workweek compromised resident training (96%) and decreased resident surgical experience (98%). Respondents also believed that the 80-hour workweek threatened patient safety (96% of program directors and 78% o...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity

Jagannathan¹,

Vates

Pouratian³

et al. 2009

JNS

139

View full text Add to dashboard Cite

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“…5,9,[11][12][13][14][15][16] This draft questionnaire was then circulated for comment to members of the RCP Trainees Committee, Academy of Medical Royal Colleges (AMRC) Trainees Group (the Chairs or Deputy Chairs of all the Medical Royal Colleges' trainees committees), the BMA Junior Doctors Committee and Medical Students Committee, and the RCP Working Party on Medical Professionalism. Responses were collated and two main recommendations were taken forward: keep it short and make responses anonymous.…”

Section: Methodsmentioning

confidence: 99%

Medical professionalism: the trainees’ views

2006

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-Medical professionalism is deeply embedded in medical practice in the UK but, with changes in the modern healthcare climate, its nature and role have been increasingly challenged. The Royal College of Physicians (RCP) therefore convened a working party to consider the concept of medical professionalism, to clarify its value and purpose, and to define it. As part of this project, the RCP Trainees Committee was commissioned to survey trainees to obtain their views on the matter. A questionnaire was sent to 19,190 medical and surgical trainees, and 4,576 medical students; 2,175 responses were received. The results were clear. Junior doctors and medical students see medicine as a profession which is learnt through apprenticeship and defined by responsibility towards patients, and which requires qualities such as altruism and humility. They believe that professionalism maintains and improves patient care; that standards of care should be defined and regulated by the profession; and that training should be directed by the profession. Furthermore, the overwhelming majority think that a reduction in medical professionalism would lead to people leaving the profession. KEY WORDS: junior doctors, medical professionalism, medical students, survey, training grade doctors IntroductionProfessionalism has for a long time been considered an intrinsic part of the practice of medicine, but with changes in the doctor-patient relationship, and more globally in the way medical care is delivered, the nature and role of medical professionalism has been increasingly questioned. Self-doubt has not been restricted to the profession of medicine; evidence points to the erosion of trust in all professions. 1 The other traditional professions, of law and the Church, have also increasingly questioned their role in society. 2 The debate about professionalism is not a new one; sociology literature has included much discussion of the subject since the 1970s, when there were particularly savage attacks on the concepts of professionalism. 3 Professionals were seen as elitist, class biased and keen to maximise their personal profits. Indeed, these were some of the accusations levelled against clinical psychologists when they sought to achieve professional status in the 1950s. 4 Perhaps the mood was best summed up by George Bernard Shaw's statement that 'Every profession is a conspiracy against the laity' .It was sociologists who first attempted to define the characteristics of a profession. 5 By examining these, the potential threats that face all the professions in the twenty-first century can be put into context. The first characteristic is the possession of a specialised body of knowledge. With the information technology revolution and the increasing influence of the Internet on people's lives, the medical profession in particular can no longer claim to have exclusive knowledge. The second characteristic is dedication to public service. This demands that the profession put the good of society before its own. This has looked increasingly...

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“…25,30,40 The professional norms measure was developed by the study team, guided by relevant theory and research. [41][42][43] All items used a 5-point Likert response format (1, strongly disagree, to 5, strongly agree). Summary scores were created by totaling responses and dividing by the number of items completed, then transforming into 0 to 100 scales.…”

Section: Limitationsmentioning

confidence: 99%