Letters to the Editor
The Temple report highlighted that the EWTD has had the greatest impact on doctors in training within secondary care, with the surgical specialties being particularly affected. It is however, important to note that no trainee in surgery has conducted their entire postgraduate training under the EWTD, making full evaluation difficult. It is worth noting that general practice as a speciality has had trainees begin and finish their higher training under the EWTD and is currently in the process of extending the length of postgraduate training by 25%. The introduction of EWTD-compliant on-call rotas did result in lost training opportunities, as the cohesive relationship between individual trainers and the trainees was, if not broken, then strained. This is much more marked in surgical specialities, where the unplanned care divides the direct relationship between trainers and trainees. This pressure is exacerbated by the training model still relying on ‘‘learning by osmosis’’ where the sheer volume of experience allows all aspects of training to be addressed, a model that is not practicable under the EWTD. This represents an excellent opportunity for redesigning the training system to take into account the new working culture. It is possible to deduce that a more supervised training environment, with directed teaching and structured learning. However, this would require an ideological and culture shift to implement, but do point the way to a more effective restricting of hospital training program. Morkos Iskander, Urology Speciality Trainee in Urology, Department of Urology, Royal Liverpool and Broadgreen Hospitals, Liverpool, Thomas drive, L14 3PE. E-mail: [email protected].
Declaration of interest: The author reports no conflicts of interest.
defining professionalism. But they had to conclude none of the mentioned definitions is universally agreed upon. We do not agree with the idea that there is no definition of professionalism possible. However, we do agree with the authors when they conclude: ‘‘the semantics of professionalism obfuscate more than they clarify’’. Therefore, we plea for a very simple definition of professionalism. Boerhaave’s (1668–1738, founder of clinical teaching), motto was: simplex sigillum veri. Simplicity is the sign of truth. We can keep it simple and yet encompass all key concepts of professionalism. We are of the opinion that within healthcare, professionalism can be defined as placing the best interests of patients at the centre of everything you do. The first lesson in medical school is the sentence by Murphy (1857–1916, abdominal surgeon): ‘‘The patient is the center of the medical universe around which all our works revolve and towards which all our efforts tend’’. The patient is the reason we started studying medicine. The patient is the reason we go to our surgery every day. The patient is our only right to exist. Stop trying to catch all the subtleties and nuances in one definition. Please keep it simple: seek ye first the patient; and all these things shall be added unto you! Pieter C. Barnhoorn, Lecturer General Practice, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands, E-mail: p.c.barnhoorn@ lumc.nl Callum C. Youngson, Head of School of Dental Sciences, University of Liverpool, Liverpool, UK. Declaration of interest: The authors report no conflicts of interest.
References References Anwar M, Irfan S, Daly N, Amen F. 2005. EWTD has negative impact on training for surgeons. BMJ 331(7530):1476. Fitzgerald JE, Caesar BC. 2012. The European Working Time Directive: A practical review for surgical trainees. Int J Surg 10(8):399–403.
Defining professionalism: Simplex sigillum veri!
Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. 2014. Defining professionalism in medical education: A systematic review. Med Teach 36:47–61. Erde EL. 2008. Professionalism’s facets: Ambiguity, ambivalence, and nostalgia. J Med Philos 33:6–26.
Comments on ‘‘Defining professionalism in medical education: A systematic review’’
Dear Sir In the last issue of this journal, Birden and colleagues wrote a systematic review of the literature to identify how professionalism is defined in the medical education literature (Birden et al. 2014). They begin their review with a quote by Erde: ‘‘I do not strive for a clear and unambiguous definition of ‘professionalism’ because I do not believe one is possible’’ (Erde 2008). Subsequently they describe their search through the literature: they identified 195 studies on the topic of
Dear Sir Professionalism teaching is often delivered to medical undergraduates through stereotypical, rule-based, ethical scenarios. It was with great interest, however, that we read the recent meta-analysis by Birden et al. (2014) which considered the definition of professionalism in the context of medical education. One key point argued is that professionalism is better taught through role models, both good and bad, through
545
Letters to the Editor
a narrative dialogue which considers the behaviours of doctors within the context of modern medical practice. This theory is the guiding principle which underlies the recent introduction of a new professionalism tutorial at Cardiff University School of Medicine, UK, replacing previous didactic teaching. The session, based on the idea of medical ‘‘heroes and anti-heroes’’, encouraged students to design and deliver short presentations on recent obituaries or fitness to practice cases. In turn, these presentations generated discussions amongst other students in the tutorial. We used evaluation forms to gain feedback from students on their perspective of this new style of professionalism teaching. Of 81 responses, 73% of the students felt that this interactive method of learning was more effective than a lecture-based approach, and 95% of the students found the session to be at least fairly effective in teaching the duties of a doctor. Sixty-five percent of the students felt that the session was effective or very effective in teaching what constitutes unprofessional behaviour by medical professionals. One criticism we found, however, was that the students felt unprepared for the session, due to the fact that no structured learning outcomes were provided. Despite this, students commented that this facilitated engaging discussions, as a wide range of presentations were produced. From this research, it is clear that the theories drawn together by the Birden et al. article can be realistically translated into improved medical teaching for undergraduates. Professionalism is a key aspect of medical training, as highlighted by the General Medical Council’s document ‘‘Tomorrow’s Doctors’’ (General Medical Council 2009). It is our hope that through better professionalism education, many of the ethical pitfalls encountered by doctors further into their careers can be prevented. Shivali Fulchand, James Kilgour & Alex Anstey, Cardiff University School of Medicine, The Cochrane Building, Heath Park, Cardiff, CF14 4YU, UK. E-mail: [email protected] Declaration of interest: The authors report no conflicts of interest.
References Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. 2014. Defining professionalism in medical education: A systematic review. Med Teach 36(1):47–61. General Medical Council. 2009. Tomorrow’s doctors. London: GMC.
Managing student anxiety during curriculum change
Dear Sir ‘‘Communicate, communicate, communicate’’ is one of 12 Tips suggested by Cookson (2013) when setting up a new medical 546
school. We found that communication was also of fundamental importance in managing student anxiety during our recent change from an undergraduate MBBS degree to a post-graduate Doctor of Medicine program. The curriculum transition necessitated a six-month overlap of new and old cohorts at a similar stage in their clinical training. Clinical School staff expected the new MD students would have typical ‘‘first cohort’’ anxiety; however, it became apparent that the outgoing MBBS students were also anxious. Through the use of face to face meetings and online questionnaires we found that the two curricula groups had quite different areas of concern. The MBBS students were most apprehensive about potential effects on their examination results through decreased access to patients, tutors, operating theatres and ward rounds. The MD students were concerned that the new curriculum was not ‘‘tried and tested’’ and that important content might be omitted in the transition to the new program. It was also apparent that these students acutely felt the absence of a preceding cohort to guide them. We attempted a number of strategies to alleviate concerns. Additional ward-based teaching was scheduled for the MBBS students as well as meetings with clinical school staff, feedback sessions and practice exams. Regular meetings were held between clinical school staff and MD students to provide reassurance and guidance in navigating the new teaching program. In response to concerns raised, senior students were recruited to assist with OSCE preparation and study skills sessions and seminars on dealing with stress were offered. In situations where there is a major curriculum change, it is to be expected that students – both outgoing and incoming – will have concerns. Our experience suggests that at a time of change students need as much information as possible and realistic discussions of what problems they might expect. Acknowledging their concerns, having open lines of communication and working together to find solutions is critically important. Anna T. Ryan, Barbara D. Goss, Joshua M. Waring & Richard C. O’Brien, Austin Hospital Clinical School, The University of Melbourne, Heidelberg, Victoria 3084, Australia. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest.
Reference Cookson J. 2013. Twelve tips on setting up a new medical school. Med Teach 35(8):715–719.
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
The Temple report highlighted that the EWTD has had the greatest impact on doctors in training within secondary care, with the surgical specialties being particularly affected. It is however, important to note that no trainee in surgery has conducted their entire postgraduate training under the EWTD, making full evaluation difficult. It is worth noting that general practice as a speciality has had trainees begin and finish their higher training under the EWTD and is currently in the process of extending the length of postgraduate training by 25%. The introduction of EWTD-compliant on-call rotas did result in lost training opportunities, as the cohesive relationship between individual trainers and the trainees was, if not broken, then strained. This is much more marked in surgical specialities, where the unplanned care divides the direct relationship between trainers and trainees. This pressure is exacerbated by the training model still relying on ‘‘learning by osmosis’’ where the sheer volume of experience allows all aspects of training to be addressed, a model that is not practicable under the EWTD. This represents an excellent opportunity for redesigning the training system to take into account the new working culture. It is possible to deduce that a more supervised training environment, with directed teaching and structured learning. However, this would require an ideological and culture shift to implement, but do point the way to a more effective restricting of hospital training program. Morkos Iskander, Urology Speciality Trainee in Urology, Department of Urology, Royal Liverpool and Broadgreen Hospitals, Liverpool, Thomas drive, L14 3PE. E-mail: [email protected].
Declaration of interest: The author reports no conflicts of interest.
defining professionalism. But they had to conclude none of the mentioned definitions is universally agreed upon. We do not agree with the idea that there is no definition of professionalism possible. However, we do agree with the authors when they conclude: ‘‘the semantics of professionalism obfuscate more than they clarify’’. Therefore, we plea for a very simple definition of professionalism. Boerhaave’s (1668–1738, founder of clinical teaching), motto was: simplex sigillum veri. Simplicity is the sign of truth. We can keep it simple and yet encompass all key concepts of professionalism. We are of the opinion that within healthcare, professionalism can be defined as placing the best interests of patients at the centre of everything you do. The first lesson in medical school is the sentence by Murphy (1857–1916, abdominal surgeon): ‘‘The patient is the center of the medical universe around which all our works revolve and towards which all our efforts tend’’. The patient is the reason we started studying medicine. The patient is the reason we go to our surgery every day. The patient is our only right to exist. Stop trying to catch all the subtleties and nuances in one definition. Please keep it simple: seek ye first the patient; and all these things shall be added unto you! Pieter C. Barnhoorn, Lecturer General Practice, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands, E-mail: p.c.barnhoorn@ lumc.nl Callum C. Youngson, Head of School of Dental Sciences, University of Liverpool, Liverpool, UK. Declaration of interest: The authors report no conflicts of interest.
References References Anwar M, Irfan S, Daly N, Amen F. 2005. EWTD has negative impact on training for surgeons. BMJ 331(7530):1476. Fitzgerald JE, Caesar BC. 2012. The European Working Time Directive: A practical review for surgical trainees. Int J Surg 10(8):399–403.
Defining professionalism: Simplex sigillum veri!
Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. 2014. Defining professionalism in medical education: A systematic review. Med Teach 36:47–61. Erde EL. 2008. Professionalism’s facets: Ambiguity, ambivalence, and nostalgia. J Med Philos 33:6–26.
Comments on ‘‘Defining professionalism in medical education: A systematic review’’
Dear Sir In the last issue of this journal, Birden and colleagues wrote a systematic review of the literature to identify how professionalism is defined in the medical education literature (Birden et al. 2014). They begin their review with a quote by Erde: ‘‘I do not strive for a clear and unambiguous definition of ‘professionalism’ because I do not believe one is possible’’ (Erde 2008). Subsequently they describe their search through the literature: they identified 195 studies on the topic of
Dear Sir Professionalism teaching is often delivered to medical undergraduates through stereotypical, rule-based, ethical scenarios. It was with great interest, however, that we read the recent meta-analysis by Birden et al. (2014) which considered the definition of professionalism in the context of medical education. One key point argued is that professionalism is better taught through role models, both good and bad, through
545
Letters to the Editor
a narrative dialogue which considers the behaviours of doctors within the context of modern medical practice. This theory is the guiding principle which underlies the recent introduction of a new professionalism tutorial at Cardiff University School of Medicine, UK, replacing previous didactic teaching. The session, based on the idea of medical ‘‘heroes and anti-heroes’’, encouraged students to design and deliver short presentations on recent obituaries or fitness to practice cases. In turn, these presentations generated discussions amongst other students in the tutorial. We used evaluation forms to gain feedback from students on their perspective of this new style of professionalism teaching. Of 81 responses, 73% of the students felt that this interactive method of learning was more effective than a lecture-based approach, and 95% of the students found the session to be at least fairly effective in teaching the duties of a doctor. Sixty-five percent of the students felt that the session was effective or very effective in teaching what constitutes unprofessional behaviour by medical professionals. One criticism we found, however, was that the students felt unprepared for the session, due to the fact that no structured learning outcomes were provided. Despite this, students commented that this facilitated engaging discussions, as a wide range of presentations were produced. From this research, it is clear that the theories drawn together by the Birden et al. article can be realistically translated into improved medical teaching for undergraduates. Professionalism is a key aspect of medical training, as highlighted by the General Medical Council’s document ‘‘Tomorrow’s Doctors’’ (General Medical Council 2009). It is our hope that through better professionalism education, many of the ethical pitfalls encountered by doctors further into their careers can be prevented. Shivali Fulchand, James Kilgour & Alex Anstey, Cardiff University School of Medicine, The Cochrane Building, Heath Park, Cardiff, CF14 4YU, UK. E-mail: [email protected] Declaration of interest: The authors report no conflicts of interest.
References Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. 2014. Defining professionalism in medical education: A systematic review. Med Teach 36(1):47–61. General Medical Council. 2009. Tomorrow’s doctors. London: GMC.
Managing student anxiety during curriculum change
Dear Sir ‘‘Communicate, communicate, communicate’’ is one of 12 Tips suggested by Cookson (2013) when setting up a new medical 546
school. We found that communication was also of fundamental importance in managing student anxiety during our recent change from an undergraduate MBBS degree to a post-graduate Doctor of Medicine program. The curriculum transition necessitated a six-month overlap of new and old cohorts at a similar stage in their clinical training. Clinical School staff expected the new MD students would have typical ‘‘first cohort’’ anxiety; however, it became apparent that the outgoing MBBS students were also anxious. Through the use of face to face meetings and online questionnaires we found that the two curricula groups had quite different areas of concern. The MBBS students were most apprehensive about potential effects on their examination results through decreased access to patients, tutors, operating theatres and ward rounds. The MD students were concerned that the new curriculum was not ‘‘tried and tested’’ and that important content might be omitted in the transition to the new program. It was also apparent that these students acutely felt the absence of a preceding cohort to guide them. We attempted a number of strategies to alleviate concerns. Additional ward-based teaching was scheduled for the MBBS students as well as meetings with clinical school staff, feedback sessions and practice exams. Regular meetings were held between clinical school staff and MD students to provide reassurance and guidance in navigating the new teaching program. In response to concerns raised, senior students were recruited to assist with OSCE preparation and study skills sessions and seminars on dealing with stress were offered. In situations where there is a major curriculum change, it is to be expected that students – both outgoing and incoming – will have concerns. Our experience suggests that at a time of change students need as much information as possible and realistic discussions of what problems they might expect. Acknowledging their concerns, having open lines of communication and working together to find solutions is critically important. Anna T. Ryan, Barbara D. Goss, Joshua M. Waring & Richard C. O’Brien, Austin Hospital Clinical School, The University of Melbourne, Heidelberg, Victoria 3084, Australia. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest.
Reference Cookson J. 2013. Twelve tips on setting up a new medical school. Med Teach 35(8):715–719.
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
