• Trish Uniac

redefining professionalism

I first wrote this in 2014, reflecting on my early practice, very recent residency experience and my past medical student experience. It still feels incredibly true, particularly in light of the disgraceful article in the Journal of Vascular Surgery which has prompted the hashtag #MedBikini. And I've got to tell you, I'm here for the backlash.


 

Especially at this time of year, when med students are being introduced to their profession, I hear the word professionalism getting thrown around. It drives me a little crazy because what the administration, vice deans, etc. actually mean is "please don't embarrass us".



The subtle threats of discipline are based on a very narrow definition of professionalism. The powers that be (PTBs), want med students to behave like sweet children at all times. Med students should drink responsibly. They should use Facebook for only chaste reasons. They should not introduce themselves as doctor until they have actually finished med school and have an MD.


The PTBs are a little right. These acts are indeed part of what makes a medical student professional. But to be a physician whose colleagues will consider professional, there are many more "soft" skills these students need to become proficient with.


1. Social Media. SoMe is not the devil. It should be embraced by physicians and those in training. This article from the BMJ does a good job of briefly outlining the risks and benefits of practicing medicine in a world with social media. I use Twitter to keep on top of new research in family medicine and emergency medicine. Following other physicians on Twitter and blogs puts the basics learned in classrooms into a clinical perspective so that students' medical education is integrated, and, more importantly, self-directed.


2. Self-directed learning. To continue growing as a physician, we need to keep ourselves motivated to follow clinical questions that pop up during the day and learn the skills required to do this. The idea of a flipped classroom starts to put the onus on students to prepare and do work outside of the classroom. I dream of a med school where all the teachers are passionate about their subjects and happy to put effort into preparing both the pre-work and the actual activities. Can you imagine these teachers working together to bring med students from being given predigested information to being able to answer questions similar to what will come up in real-life practice? Encouraging students to feel comfortable asking for clarification? Molding these students into future colleagues they want to work with?


Ideally, by the end of the classroom portion of med school, the students would be ready for self-evaluations of their work. Students should feel comfortable with what they do and do not know, and being comfortable with the vulnerability needed to ask for their teachers' opinions of their progress.


3. Communication. Not just using your doctor words, but learning how to have conversations with colleagues that are uncomfortable. Being able to disagree, admit you were wrong or that you made a mistake, asking for help, asking someone who knows more about a topic to teach you. These are all skills a professional doctor possesses. Our small groups, flipped classrooms, and clinical teaching environments are perfect places to cultivate these skills. We should be encouraging all teachers to work on communication with their med students while also teaching how to take a pulse. Praise the student who says they have no idea what they are supposed to be feeling for in a pelvic exam or are not sure how to read the chest x-ray. Don't demean these students or treat them like they're a waste of your time. These are the future colleagues that won't be too cocky to ask for the second opinion that could save a patient's life.


4. Self Care. A burned-out physician is useless to their patients and to their colleagues. Learning how to take care of their mental and physical well being needs to get more than just lip service in medical schools. I have a lot more to rant about this, and will. Later.


5. Advocacy. Pick something that you love. Learn more about it. Make the world a better place. Most PTBs are pretty good about encouraging this, especially because when med students do good things, it makes up for all those times they embarrass their schools.


6. Compassion for each other. The competition that got us into med school can turn into icky feelings when we are thrown together for more than 4 years of intense, sleep-deprived, time together. It's time to learn how to get along, how to make each other into the best docs possible. This includes all that I mentioned above. Do you have a secret that makes studying for anatomy a lot easier? Share it with your anatomy table, or hell, why not the whole class. Is someone missing from class for days at a time? Quietly check-in to see if they need notes, a beer, or a shoulder to cry on. Something my small groups and I do is a weekly "check-in" to encourage this behaviour. We start our sessions by discussing what important (or interesting) thing happened this week. I learned about my students' struggles with head and neck anatomy and watched as they helped each other through it. When a student disclosed a horrific event from his past, I was proud to see his classmates reaching out figuratively and literally to console him and thank him for sharing.


Medical students want to make the world a better place. Practicing professionalism through their education will help them to make that happen.


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