Supporting professionalism and professional identity formation at the postgraduate level

doi:10.1017/CBO9781316178485.019

17 - Supporting professionalism and professional identity formation at the postgraduate level

from Part IV - Case studies in promoting professionalism and professional identity formation across the continuum

Published online by Cambridge University Press: 05 April 2016

Edited by

Sylvia R. Cruess and

Linda Snell: Affiliation:
McGill University, Montreal, Quebec, Canada
Richard L. Cruess: Affiliation:
McGill University, Montréal
Sylvia R. Cruess: Affiliation:
McGill University, Montréal
Yvonne Steinert: Affiliation:
McGill University, Montréal

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Summary

It is during the … years that medical graduates spend as residents and clinical fellows that doctors come of professional age – acquiring the knowledge and skills of their specialties or subspecialties, forming professional identities, and developing habits, behaviors, attitudes, and values that last a professional lifetime.1 (p. 2)

Postgraduate medical education is a unique educational environment, with its emphasis on work-based learning, clinical supervision as a predominant method of training, performance-based assessment, and the challenge of simultaneously delivering education, training, and service.2 (p. 3)

Introduction

Learning how to be a professional is an essential part of residency – that period of time between end of medical school and unsupervised practice. Although professional socialization starts in medical school, professional values and behaviors are internalized and a physician's identity is formed to a great extent during residency. Despite this, there are few publications on teaching or assessing professionalism in residency or on how to influence the development of a professional identity at the postgraduate level. This chapter incorporates what has been learned at the undergraduate level and from the literature on identity formation to discuss the context, theory, and practice of how professionalism can be taught and assessed at the residency level. It also links learning, assessment, and institutional strategies to the development of a professional identity as a physician during residency education. The importance of producing professional physicians, and the central importance of residency education in this process, is underscored by both positive and negative examples. Papadakis et al.3 correlate poor performance on professionalism measures during postgraduate education with more disciplinary actions in practice. On the other hand, Wright4 underlines the importance of identifying and emulating positive role models, and their particular influence at the residency level. However, despite the calls for professional identity formation to be a foundational part of medical education during the residency years,5 “traditional residency education has not attended to shepherding new physicians through this process.”

Residency: the context

Compared to medical school, the largest part of learning during residency is work based, with an emphasis on education situated primarily in clinical settings: the workplace. As such, there are characteristics of this setting that have a strong influence on learning professionalism and fostering identity development.

Type: Chapter
Information: Teaching Medical Professionalism
Supporting the Development of a Professional Identity
, pp. 248 - 260

DOI: https://doi.org/10.1017/CBO9781316178485.019 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2016

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References

1. Ludmerer, KM. Let Me Heal: The Opportunity to Preserve Excellence in American Medicine. Oxford, UK: Oxford University Press; 2015.

2. Steinert, Y. Faculty Development for Postgraduate Education – The Road Ahead. Members of the FMEC PG consortium; 2011. [Accessed June 25, 2015.] Available from www.afmc.ca/pdf/fmec/21_Steinert_Faculty%20Development.pdf.

3. Papadakis, MA, Arnold, GK, Blank, LL, Holmboe, ES, Lipner, RS. Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards. Ann Intern Med. 2008; 148(11):869–76.Google Scholar

4. Wright, S. Examining what residents look for in their role models. Acad Med. 1996; 71(3):290–92.Google Scholar

5. Cooke, M, Irby, DM, O'Brien, BC. Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco, CA: Jossey-Bass; 2010.

6. Nothnagle, M, Reis, S, Goldman, RE, Anandarajah, G. Fostering professional formation in residency: development and evaluation of the “forum” seminar series. Teach Learn Med. 2014; 26(3):230–38.Google Scholar

7. Varpio, L, Bidlake, E, Casimiro, L, Hall, P, Kuziemsky, C, Brajtman, S, Humphrey-Murto, S. Resident experiences of informal education: how often, from whom, about what and how. Med Educ. 2014; 48(12):1220–34.Google Scholar

8. Ludmerer, KM. The history of calls for reform in graduate medical education and why we are still waiting for the right kind of change. Acad Med. 2012; 87(1):34–40.Google Scholar

9. Leach, DC. Resident formation – a journey to authenticity: designing a residency program that educes professionalism. In Cruess, R, Cruess, S, Steinert, Y, eds. Teaching Medical Professionalism. New York, NY: Cambridge University Press; 2009:93–107.

10. Holmboe, E, Ginsburg, S, Bernabeo, E. The rotational approach to medical education: time to confront our assumptions? Med Educ. 2011; 45(1):69–80.Google Scholar

11. Brownell, AK, Côté, L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001; 76(7):734–37.Google Scholar

12. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. Reframing medical education to support professional identity formation. Acad Med. 2014; 89(11):1446–51.Google Scholar

13. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015; 90(6):718–25.Google Scholar

14. Balmer, D, Serwint, JR, Ruzek, SB, Ludwig, S, Giardino, AP. Learning behind the scenes: perceptions and observations of role modeling in pediatric residents’ continuity experience. Ambul Pediatr. 2007; 7(2):176–81.Google Scholar

15. Cruess, SR, Cruess, RL, Steinert, Y. Role modelling–making the most of a powerful teaching strategy. BMJ. 2008; 336(7646):718–21.Google Scholar

16. Sternszus, R, Cruess, S, Cruess, R, Young, M, Steinert, Y. Residents as role models: impact on undergraduate trainees. Acad Med. 2012; 87(9):1282–87.Google Scholar

17. Baldwin, DC Jr, Daugherty, SR, Rowley, BD. Unethical and unprofessional conduct observed by residents during their first year of training. Acad Med. 1998; 73(11):1195–1200.Google Scholar

18. Wright, SM, Kern, DE, Kolodner, K, Howard, DM, Brancati, FL. Attributes of excellent attending-physician role models. N Engl J Med. 1998; 339(27):1986–93.Google Scholar

19. Nguyen, QD, Fernandez, N, Karsenti, T, Charlin, B. What is reflection? A conceptual analysis of major definitions and a proposal of a five‐component model. Med Educ. 2014; 48(12):1176–89.Google Scholar

20. Gordon, MJ. Cutting the Gordian knot: a two-part approach to the evaluation and professional development of residents. Acad Med. 1997; 72(10):876–80.Google Scholar

21. Forgeron, MP. A resident's perspective on professionalism. Annals RCPSC. 2001; 35(1):45–47.Google Scholar

22. Stern, DT, ed. Measuring Medical Professionalism. New York, NY: Oxford University Press; 2006.

23. Epstein, RM. Assessment in medical education. N Engl J Med. 2007; 356(4):387–96.Google Scholar

24. Sherbino, J, Bandiera, G, Frank, JR. Assessing competence in emergency medicine trainees: an overview of effective methodologies. CJEM. 2008; 10(4):365–71.Google Scholar

25. Cruess, R, Cruess, S, Steinert, Y. Amending Miller's Pyramid to include professional identity formation. Acad Med. 2015. In press.

26. Gordon, J, Markham, P, Lipworth, W, Kerridge, I, Little, M. The dual nature of medical enculturation in postgraduate medical training and practice. Med Educ. 2012; 46(9):894–902.Google Scholar

27. Jarvis-Selinger, S, Pratt, DD, Regehr, G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012; 87(9):1185–90.Google Scholar

28. Corrigan, O, Ellis, K, Bleakley, A, Brice, J. Quality in medical education. In Swanwick, T, ed. Understanding Medical Education: Evidence, Theory and Practice. Oxford, UK: Wiley-Blackwell; 2010:379–91.

29. Swing, SR. The ACGME outcome project: retrospective and prospective. Med Teach. 2007; 29(7):648–54.Google Scholar

30. Frank, JR, Snell, L, Sherbino, J, eds. Draft CanMEDS 2015 Physician Competency Framework. Ottawa, ON: Royal College of Physicians and Surgeons of Canada; 2015. [Accessed June 25, 2015.] Available from www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/canmeds2015_framework_series_IV_e.pdf.

31. Pratt, MG, Rockmann, KW, Kaufmann, JB. Constructing professional identity: the role of work and identity learning cycles in the customization of identity among medical residents. Acad Manage J. 2006; 49(2):235–62.Google Scholar

32. Raymond, MR, Mee, J, King, A, Haist, SA, Winward, ML. What a new residents do during their initial months of training. Acad Med. 2011; 86(10 Suppl):S59–S62.Google Scholar

33. Wright, SM, Levine, RB, Beasley, B, Haidet, P, Gress, TW, Caccamese, S, Brady, D, Marwaha, A, Kern, DE. Personal growth and its correlates during residency training. Med Educ. 2006; 40(8):737–45.Google Scholar

34. Yeo, H, Viola, K, Berg, D, Lin, Z, Nunez-Smith, M, Cammann, C, Bell, RH Jr, Sosa, JA, Krumholz, HM, Curry, LA. Attitudes, training experiences, and professional expectations of US surgery residents: a national survey. JAMA. 2009; 302(12):1301–08.Google Scholar

35. Baldwin, DC Jr, Daugherty, SR, Ryan, PM, Yaghmour, NA. What do residents do when not working or sleeping? A multispecialty survey of 36 residency programs. Acad Med. 2012; 87(4):395–402.Google Scholar

36. Ludmerer, KM, Johns, MM. Reforming graduate medical education. JAMA. 2005; 294(9):1083–87.Google Scholar

37. Cruess, RL, Cruess, SR. Teaching professionalism: general principles. Med Teach. 2006; 28(3):205–08.Google Scholar

38. ABIM Foundation, American Board of Internal Medicine; ACP-ASIM Foundation, American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136(3):243–46.

39. Dore, KL, Kreuger, S, Ladhani, M, Rolfson, D, Kurtz, D, Kulasegaram, K, Cullimore, AJ, Norman, GR, Eva, KW, Bates, S, Reiter, HI. The reliability and acceptability of the Multiple Mini-Interview as a selection instrument for postgraduate admissions. Acad Med. 2010; 85(10 Suppl):S60–S63.Google Scholar

40. Hofmeister, M, Lockyer, J, Crutcher, R. The multiple mini-interview for selection of international medical graduates into family medicine residency education. Med Educ. 2009; 43(6):573–79.Google Scholar

41. Cruess, RL, Cruess, SR, Snell, L, Ginsburg, S, Kearney, R, Ruhe, V, Ducharme, S, Sternszus, R. Teaching, Learning and Assessing Professionalism at the Post Graduate Level. Members of the FMEC PG consortium; 2011. [Accessed June 25, 2015.] Available from www.afmc.ca/pdf/fmec/20_Cruess_Professionalism.pdf.

42. Sklar, DP. How do I figure out what I want to do if I don't know who I am supposed to be? Acad Med. 2015; 90(6):695–96.Google Scholar

43. Khandelwal, A, Nugus, P, Elkoushy, MA, Cruess, RL, Cruess, SR, Smilovitch, M, Andonian, S. How we made professionalism relevant to twenty-first century residents. Med Teach. 2015; 37(6):538–42.Google Scholar

44. Klein, EJ, Jackson, JC, Kratz, L, Marcuse, EK, McPhillips, HA, Shugerman, RP, Watkins, S, Stapleton, FB. Teaching professionalism to residents. Acad Med. 2003; 78(1):26–34.Google Scholar

45. Markakis, KM, Beckman, HB, Suchman, AL, Frankel, RM. The path to professionalism: cultivating humanistic values and attitudes in residency training. Acad Med. 2000; 75(2):141–50.Google Scholar

46. Goold, SD, Stern, DT. Ethics and professionalism: what does a resident need to learn? Am J Bioeth. 2006; 6(4):9–17.Google Scholar

47. Grewal, D, Davidson, HA. Emotional intelligence and graduate medical education. JAMA. 2008; 300(10):1200–02.Google Scholar

48. Taylor, C, Farver, C, Stoller, JK. Perspective: Can emotional intelligence training serve as an alternative approach to teaching professionalism to residents? Acad Med. 2011; 86(12):1551–54.Google Scholar

49. Snell, L. Teaching professionalism and fostering professional values during residency: the McGill experience. In Cruess, R, Cruess, S, Steinert, Y, eds. Teaching Medical Professionalism. New York, NY: Cambridge University Press; 2009:246–62.

50. Borrero, S, McGinnis, KA, McNeil, M, Frank, J, Conigliaro, RL. Professionalism in residency training: is there a generation gap? Teach Learn Med. 2008; 20(1):11–17.Google Scholar

51. Reed, DA, West, CP, Mueller, PS, Ficalora, RD, Engstler, GJ, Beckman, TJ. Behaviors of highly professional resident physicians. JAMA. 2008; 300(11):1326–33.Google Scholar

52. Branch, WT Jr, Kern, D, Haidet, P, Weissmann, P, Gracey, CF, Mitchell, G, Inui, T. The patient-physician relationship. Teaching the human dimensions of care in clinical settings. JAMA. 2001; 286(9):1067–74.Google Scholar

53. Larkin, GL. Mapping, modeling, and mentoring: charting a course for professionalism in graduate medical education. Camb Q Healthc Ethics. 2003; 12(2):167–77.Google Scholar

54. Walsh, A, Antao, V, Bethune, C, Cameron, S, Cavett, T, Clavet, D, Dove, M, Koppula, S. Fundamental Teaching Activities in Family Medicine: A Framework for Faculty Development. Mississauga, ON: College of Family Physicians of Canada; 2015. [Accessed June 25, 2015.] Available from www.cfpc.ca/uploadedFiles/Education/_PDFs/FTA_GUIDE_TM_ENG_Apr15_REV.pdf.

55. Ratanawongsa, N, Wright, SM, Carrese, JA. Well-being in residency: a time for temporary imbalance? Med Educ. 2007; 41(3):273–80.Google Scholar

56. Lurie, SJ, Mooney, CJ, Lyness, JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med. 2009; 84(3):301–09.Google Scholar

57. Cruess, R, McIlroy, JH, Cruess, S, Ginsburg, S, Steinert, Y. The Professionalism Mini-Evaluation Exercise: a preliminary investigation. Acad Med. 2006; 81 (10 Suppl):S74–S78.Google Scholar

58. Tsugawa, Y, Tokuda, Y, Ohbu, S, Okubo, T, Cruess, R, Cruess, S, Ohde, S, Okada, S, Hayashida, N, Fukui, T. Professionalism Mini-Evaluation Exercise for medical residents in Japan: a pilot study. Med Educ. 2009; 43(10):968–78.Google Scholar

59. Ginsburg, S, Gold, W, Cavalcanti, RB, Kurabi, B, McDonald-Blumer, H. Competencies “plus”: the nature of written comments on internal medicine residents’ evaluation forms. Acad Med. 2011; 86(10 Suppl):S30–S34.Google Scholar

60. Frohna, A, Stern, D. The nature of qualitative comments in evaluating professionalism. Med Educ. 2005; 39(8):763–68.Google Scholar

61. Gauger, PG, Gruppen, LD, Minter, RM, Colletti, LM, Stern, DT. Initial use of a novel instrument to measure professionalism in surgical residents. Am J Surg. 2005; 189(4):479–87.Google Scholar

62. Larkin, GL, Binder, L, Houry, D, Adams, J. Defining and evaluating professionalism: a core competency for graduate emergency medicine education. Acad Emerg Med. 2002; 9(11):1249–56.Google Scholar

63. Steinert, Y, Cruess, S, Cruess, R, Snell, L. Faculty development for teaching and evaluating professionalism: from programme design to curriculum change. Med Educ. 2005; 39(2):127–36.Google Scholar

64. Lopez, L, Katz, JT. Perspective: creating an ethical workplace: reverberations of resident work hours reform. Acad Med. 2009; 84(3):315–19.Google Scholar

65. Taylor, TS, Nisker, J, Lingard, L. To stay or not to stay? A grounded theory study of residents’ postcall behaviors and their rationalizations for those behaviors. Acad Med. 2013; 88(10):1529–33.Google Scholar

66. Sun, NZ, Gan, R, Snell, L, Dolmans, D. Resident duty hour reform – erosion of professionalism or catalyst for evolution? Acad Med. 2015. In press.

67. Ratanawongsa, N, Bolen, S, Howell, EE, Kern, DE, Sisson, SD, Larriviere, D. Residents’ perceptions of professionalism in training and practice: barriers, promoters, and duty hours requirements. J Gen Intern Med. 2006; 21(7):758–63.Google Scholar

68. Young, ME, Cruess, SR, Cruess, RL, Steinert, Y. The Professionalism Assessment of Clinical Teachers (PACT): the reliability and validity of a novel tool to evaluate professional and clinical teaching behaviors. Adv Health Sci Educ Theory Pract. 2014; 19(1):99–113.Google Scholar

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