Presentation given by Sandra Zijlstra-Shaw at the Dental Education Journal Club, 12 November 2012. What is professionalism in medicine and dentistry, how do we assess it?

1. Assessment of
Professionalism
Dental Education Journal Club
University of Sheffield
School of Clinical Dentistry
S. Zijlstra-Shaw
November 2012

2. Journal articles
Integrating professionalism
Assessing professionalism
into the curriculum:
within dental education:
the need for a definition AMEE Guide No. 61
S. Zijlstra-Shaw, P. G.Robinson and Helen O‟Sullivan, Walther van
T.E. Roberts, Mook, Ray Fewtrell & Val Wass
Eur J Dent Educ Medical Teacher
2012;16(1):e128-36 2012; 34: e64–e77

3. Assessment of Professionalism
• The GDC puts professionalism at the heart of our agenda.
• The scope of what the GDC requires of students goes beyond
academic achievement, and incorporates the attitudes, values and
behaviours needed for registration.
• The education or training provider must ensure anyone involved in
the supervision and training of students is adequately trained to
carry out the role, both clinically and as appropriate in terms of
assessment and reporting of student progress
The General Dental Council Preparing for practice Dental team learning outcomes for registration 2012

4. What is Professionalism?
Professionalism is defined as
the body of qualities or features
characteristic of a profession
O.E.D. 1993

5. Characteristics of a Profession
The essential attributes of a profession are having
• A systematic body of knowledge
• Professional authority and credibility
• Regulation and control of members
• A professional code of ethics
• A culture of values, norms, and symbols.
Ernest Greenwood 1957

6. Characteristics of a Profession
Hippocratic Oath

7. Cruess & Cruess 1997
“Physicians have a unique societal role as professionals who are
dedicated to the health and caring of others. Their work requires the
mastery of a complex body of knowledge and skills, as well as the
art of medicine. As such, the Professional Role is guided by codes
of ethics and a commitment to clinical competence, the embracing of
appropriate attitudes and behaviors, integrity, altruism, personal
well-being, and to the promotion of the public good within their
domain. These commitments form the basis of a social contract
between a physician and society. Society, in return, grants
physicians the privilege of profession-led regulation with the
understanding that they are accountable to those served.”

8. Medical Professionalism
“Professionalism is demonstrated through a
foundation of clinical competence,
communication skills, and ethical and legal
understanding, upon which is built the aspiration
to and wise application of the principles of
professionalism: excellence, humanism,
accountability and altruism.”
D T Stern 2006

9. What is Professionalism?
“Professionalism is also a sociological
phenomenon since professional status is
granted by society. Professionals have,
therefore, an obligation to meet the
requirements of the society in which they
practice”
Irvine D. The performance of doctors. I: Professionalism and self-regulation in a changing world.
BMJ 1997: 314 (7093):1540-1542

10. Royal College of Physicians 2005
“Medical professionalism signifies a set of values,
behaviours, and relationships that underpins the
trust the public has in doctors”
Medicine is a vocation in which a doctor‟s knowledge, clinical skills, and judgement are put in the service
of protecting and restoring human well-being. This purpose is realised through a partnership between
patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.
In their day-to-day practice, doctors are committed to:
• Integrity
• Compassion
• Altruism
• Continuous improvement
• Excellence
• Working in partnership with members of the wider healthcare team.
These values, which underpin the science and practice of medicine, form the basis for a moral contract
between the medical profession and society. Each party has a duty to work to strengthen the system of
healthcare on which our collective human dignity depends.

11. Medical Professionalism
Balance between many factors
Internal Connected to person / personality of professional
External Context, social or cultural environment
Perceived wishes of patient
Interpretation of evidence or scientific base
Hilton and Slotnick 2005

12. Professionalism is more
“commitment to one‟s work as a career so that one’s work
becomes part of one’s identity”
Eliot Freidson1970

13. Professionalism
• Personal qualities
• Societal values

14. Professionalism and Dentists
“Standards for dental professionals”
• Putting patients‟ interests first and acting to protect them.
• Respecting patients‟ dignity and choices.
• Protecting the confidentiality of patients‟ information.
• Co-operating with other members of the dental team and other
healthcare colleagues in the interests of patients.
• Maintaining your professional knowledge and competence.
• Being trustworthy
General Dental Council Standards for Dental Professionals 2005

15. Professionalism and Dentists
• A competence
• Professional attitude and behaviour
• Ethics and jurisprudence
Cowpe et al 2010 Profile and competences for the graduating European dentist –
Update 2009

16. Professionalism and Dentists
Recognise the role and responsibility of being a
registrant and demonstrate professionalism
through their education, training and practice in
accordance with GDC guidance
The General Dental Council Preparing for practice Dental team learning outcomes for registration 2012

17. Student Fitness to Practice
• GDC publication 2010

18. What is fitness to practise?
Students must demonstrate during their
education and training that they have
the knowledge, skills and attitudes
expected of a registered dentist or
dental care professional.
Student Fitness to Practice GDC April 2010

19. GDC
•greater clarity is needed in discussing professionalism,
ethics and fitness to practise Shaw 2009

20. Professionalism is MORE
• “to be real professionalism has to be
something that people – professionals –
actually „do‟..”.
Evans L, Professionalism, Professionality and the development of Education Professionals
British Journal of Educational Studies, 2008

21. Aspects of professionalism
Altruism Working with others
Autonomy Social responsibility
Excellence Trustworthiness
Compassion Self-awareness
Accountability Self-motivation
Moral Reasoning Reflection
Honesty and integrity Respect
Knowledge of ethical standards
Zijlstra-Shaw S, Robinson PG, Roberts T: Assessing professionalism within dental education; the need for a definition. Eur J Dent Educ; 2012
Feb;16(1):e128-36

22. What is Professionalism?
Agree a definition of professionalism
the first step is to define professionalism in
dentistry and develop a validated
operationalised construct

23. Assessment of Professionalism
Literature on assessment of professionalism
suggests that not only should the purpose of
assessments be clearly defined, but that the
evaluation of both the assessment tools and the
assessment system should be individually
tailored to ensure that it is appropriate.

24. Student Assessment
• Assess progress and direct future learning
• Summarise achievement
• Indicate readiness to progress
• Provide feedback
• Motivate learning
• Ensure safety and quality of care for patients
After Wood 2007

25. Aim of Assessment
Students develop an understanding of
professionalism and demonstrate
professional behaviours in everyday
practice

26. AMEE Guide
• Agree on a definition for your own institution
• Setting expectations: agreeing the framework
• Can you teach professionalism? Models of learning
• Building experience into the formal and informal curricula
• Addressing unexpected consequences: the hidden curriculum
• Assess the learning outcomes
• Evaluating programme
Integrating professionalism into the curriculum: AMEE Guide No. 61
Helen O‟Sullivan, Walther van Mook, Ray Fewtrell & Val Wass, Medical teacher 2012; 34: e64–e77

27. Assessment of Professionalism
• Agree a definition of professionalism and base learning outcomes
on this definition
• Integrate professionalism across the whole curriculum (formal,
informal and hidden)
• Provide opportunities to assess professionalism in multiple contexts,
by multiple assessors, longitudinally and triangulate the results
• Provide clear statements of the purpose of each assessment
• Ensure that the programme is evaluated and improvements made
based on the evaluations
Hawkins et al 2009, Hodges et al 2011, O‟Sullivan et al 2012

28. Assessment of Professionalism
• Begin early as this helps identify the personal traits required to be
professional
• Multiple assessment methods are needed
• Assessment should be carried out on multiple occasions
• Assessment should be carried out by multiple assessors
• Longitudinal assessment is required as the assessment of patterns
of behaviour is crucial, furthermore students develop
professionalism over time
Consilium Abeundi 2002, Van Mook et al 2009, O‟Sullivan et al 2012

29. Assessment Levels
Miller’s pyramid
Miller GE The Assessment of Clinical Skills/Competence/Performance Academic Medicine 1990: 65(9 Suppl):S63–S67

30. Assessment Categories
• Written assessment
• Competency based assessment
• Performance based assessment
• Portfolios

31. Written assessment
• Knows and Knows how levels
• MCQ‟s, SSAQ‟s, Essays etc.
• Knowledge of the judicial, legislative and
administrative processes and ethical principles
• Written journals to assess reflection

32. Competency based assessment
• Shows how level
• Standard patient encounters and Objective
structured, clinical examinations (OSCE‟s)
• Variable interpretation observable behaviour
• May not reflect actual performance
• Earlier stages of the curriculum
• “Tick-box mentality”

33. Performance based assessment
• Does level
• Working environment – variable context
• Direct observation
• Self-assessment, peer assessment, staff
assessment, 360o feedback
• Variable interpretation observable behaviour
• Reluctance to document unprofessional
behaviour

34. Portfolios
• All four levels
• Provide evidence of competence and progression
• May stimulate reflection
• Integrate multiple components
• Variation in type and content – prescriptive or
discretional
• Integration into the curriculum
• Need tutor support (training issues)
• Time consuming for students and staff

35. Challenges Assessing professionalism
Professionalism is ill-defined
• Requires clarification Arnold 2002
• no a priori evidence documenting individuals‟
beliefs about professionalism ..., an essential
first step to developing a validated assessment
instrument Jha et al., 2006

36. Challenges Assessing professionalism
A complex construct
• Intangible collections of abstract concepts and principles
• Inferred from behaviour
• Explained by educational or psychological theory
2nd order competence
• Expressed only via performance of other competences
Downing 2003
Verkerk et al., 2007

37. Integrating professionalism into the
curriculum: AMEE Guide 61
There is a risk that competence-based curricula and a
„can do‟ approach to assessment fail to encourage
motivation to continue to improve. We cannot afford to
stand still. Teaching, learning and assessment practice
must be based on evidence and, despite the already
significant literature, it is equally apparent that much
more research is required;
Integrating professionalism into the curriculum: AMEE Guide No. 61
Helen O‟Sullivan, Walther van Mook, Ray Fewtrell & Val Wass Medical teacher 2012; 34: e64–e77

38. Assessing professionalism within
dental education: the need for a
definition
In order to enhance dental education via the assessment
of students‟ professionalism, the first step is to define
professionalism in dentistry and develop a validated
operationalised construct. Then educational programmes
can be developed which teach professionalism and
students can be assessed on the domains within the
construct.
Assessing professionalism within dental education; the need for a definition.
S Zijlstra-Shaw , PG Robinson, TE Roberts Eur J Dent Educ; 2012 Feb;16(1):e128-36

39. Professionalism Assessment Strategy
• Clear goals
• Defensible
• Multiple contexts, assessors,
assessment methods
• Reward Excellence
• Incorporate Reflection
• Integrate across the curriculum
• Role Modelling/hidden curriculum
• Evaluation

40. To
Discover
And
Understand.