Evaluation of Medical Professionalism - Essay Example

A blue print to Asses Professionalism: Critical Analysis Introduction In any career, the definition of what professionalism should be is never an easy thing. This is even harder in the context of medical practice. Developing a good definition of what professional conduct is always a hard thing. This is critical because unless there is a good definition of what professional conduct is, it can never be easy to measure and evaluate it. Wilkinson, Winnie Wade, and Knock (2009) tried to look at the issue in the attempt to develop a blueprint for assessing professionalism in medical practice. Their study was comprehensive and tried to identify the components that can be used to measure professionalism. To do this, they also tried to group these components using a thematic process where those components which can be measured using similar or same tools were grouped together. They also tried to identify any gaps that may exist in the process of evaluating professionalism as well as any overlapping areas. After a comprehensive literature review, they identified that professionalism can be measured by such factors as the ability of the individual practitioner to adhere ethical practice principles, effective interactions with his or her patients as well as including people who are important to those patients in the process of treatment. They also identified that effective teamwork with people working within the same environment (workplace) is also an important issue with regard. They also considered reliability and commitment to self maintenance or self improvement of competence in oneself, others, and systems. Clusters of assessment tools The authors also looked at the cluster of tools that can be used to measure the various aspects of professionalism in medical practice. The authors, through their intensive analysis, identified that observed clinical experiences, collated views of coworkers, records of various incidents of unprofessionalism during the work process of the individual and critical incident reports were very good tools to measure the various aspects of professionalism. They also identified other tools such as simulations and paper-based tests as well as opinions of the patient that the practitioner being evaluated has treated. Global views of supervisor were also considered to be important tool for measuring and evaluating professionalism in medical practice. The authors also regarded self-administered rating scales as a viable way to measure some aspects of professionalism in medical practice. Evaluation Given the issue being investigated in the paper, the elements to be examined in order to evaluate the paper in terms of how well it was done will be as follows; Identification of issues The authors were able to carry out some very good work with regard to the identification of issues. History indicates that there has been a problem with regard to how professionalism should be measured, especially in the context of medical practice. In this regard, the authors were keen on first defining the problem which was the inexistence of a definition of what professionalism or professional conduct is. This, as Birden (2014) says, is difficult because there is no overarching concept of what medical professionalism in is. The authors say they identified over 50 articles which they used to identify how professionalism has been defined by other scholars in the past. They argue that of these, they discarded 20 of them because they seemed to replicate what earlier studies had already covered. Definition of the problem Reading the paper, even a person who is not aware of the issue is instantly informed about the issue. The authors have been able to clearly define the problems, which in this case is the fact that the lack of a consensus with regard to what professionalism or professional conduct s has led to the lack of a proper way to measure and evaluate the professionalism or professional conduct of an individual products. The authors have effectively identified the problem in terms of what has been the issue with regard to the failure to develop a solution that can solve the problem well. They have delved into the past of the issue and found that the main issue is the fact that most scholars in the past failed to recognize the lack of a consensus with regard to what professionalism or professional conduct is. By beginning here, they have not only managed to create a better foundation upon which to build their work, but have also overcome the same obstacle that the past scholars failed to overcome. Not only have they done so, but there are able to communicate to their readers about what the problem is exactly. This is very critical for this issue being investigated in the study that informed the article. Identifying gaps The authors have also done a magnificent job with regard to identifying the gaps between the available tools for measuring professionalism in medical practice and the areas of proficiency that need to be measured and evaluated. This is also very necessary for this particular issue because unless and until these gaps are closed, it is impossible to have a holistic way to assess and evaluate professionalism in medical practice Development of the blueprint The development in the blueprint for assessing and evaluating professionalism is also done in a professional way and a credible way. The authors realized that the biggest issue with developing a model for evaluation of professionalism is the fact that not all aspects of professionalism can be evaluated using the same tool. The other important take-away from the article is the fact that the authors admit that even after mapping all the available tools to the various assessment categories, there still were some professionalism elements that did not have any adequate tool to asses or evaluate them. These, they called the gaps that exist in the attempt to evaluate medical professionals with regard to their professionalism. Research The study that informed the development of this article by Wilkinson, Wade and Knock (2009) benefitted from a rigorous literature review on the issue. The authors did not just do a rigorous literature review, but also clearly logged the process of the literature review so that the readers of the article can appreciate the validity of the study that was done. They clearly outline how they went about getting the literature that has been generated in the pt about the issue. This is important because this process informs the level of credibility of the results of the study as reported in the paper. By assessing over thirty past studies and what they showed with regard to professionalism and also identifying the various tools that have been suggested, the scholars were able to come up with two major elements that would then be necessary for the development of this paper. These two things are as follows; Elements of professionalism As Ferguson, Wakeling and Bowie (2014) identified in their study, it reasonable that for a proper evaluation of professionalism to be done, elements of professionalism must be identified. Anyone looking forward to evaluate a practitioner must know what he or she is looking for. As a result, it is very essential that the authors have been able to identify the elements of professionalism that must be evaluated in order for a complete assessment of professionalism to be achieved. Like any other study, such a study has to be evaluated with regard to how it brought something new, something that is not already commonplace. In this article, the authors appreciated that the elements of professionalism have already been addressed enough other scholars in past. So their intention was to just collect as many of these professionalism elements for the purposes of grouping them thematically in order that from there, they can then determine which of these can be assessed or evaluated using which tools of evaluation. The most important point that the authors addressed here is doing a rigorous job in arranging these elements depending on their theme and what the elements are trying to measure. The authors not only appreciate that the issue of professionalism is a multifaceted issue, but also realize that there is a need to make sure that there is a way to measure these elements with the tools that will produce reliable results. This is definitely of great importance for the purposes of creating a comprehensive and holistic assessment model. Identifying he various tools that have been developed for assessing professionalism The other important thing that the authors have done in this paper is their ability to catalogue all the available tools that can be used for assessing professionalism in the workplace for medical practitioners. Again here, just like in their identification of the various elements of professionalism that must be tented to during a professional assessment, their main aim was not to develop new tools, it was merely to harvest all the tools that have been elaborated by scholars in the past. The importance of this is the fact that it helps in mapping those tools to the various categories of element of professionalism. The result is that the authors were able to identify the gaps, that is, identifying the elements of professionalism whose tools for evaluation have not been developed yet. Since this study was geared towards to developing a blueprint for evaluation of professionalism in medical practice, this can be seen as a very important part of the paper. The study, and the resulting blueprint that has been developed can be credited for one major factor; its ability to bring together all the theories and creating a standardized way of approaching professionalism assessment. Few studies, if any at all, have been able to do this and this is what has led to the gaps that have been identified in the study. This article provides very useful insights that past studies have ignored, or were unable to identify. To start, the fact that they have tried to reconcile the various assessment tools for assessing professionalism and the tools available for the same is a unique and important element of this article. This article has chosen to use a holistic view of the issue unlike in past studies where the authors concentrated on only one issue and so were not able to have a holistic view of the issue. The authors address the fact that professionalism is not a one-faceted issue but rather a multi-faceted issue that must be considered from many angles. This has empowered them to be able to address the issue in much better way that anyone has ever done. Addressing issues Some of the issues that the authors have identified with regard to the fact that the assessment tools used may not all have the same weight. For instance, they have argued that the CEX23 and P-MEX are more useful due to the fact they tend to capture the greatest number of the most important professionalism elements that can be used to measure professionalism. They also identify the concern with other tools for measuring professionalism, such as the use of patient review and opinion. They identify that although the use of patient reviews and opinion may be a good way to compliment the other assessment tools, there are at least two problems with it. The firs problem, they identify, is to the fact that in some special cases, the doctor is bound to do something that the patient will not agree with and this will lead to the patient rating the doctor negative even though the doctor acted in the most professional way in that particular situation. The second issue that the authors identify with regard to using patient reviews is the fact that if the patient are explicitly asked to review their doctors, they may end up having a low opinion on the doctors, not only making the work of the doctors hard but also making the quality of service to be low because like in any situation quality is matter of perception. How the paper increased my knowledge in the issue of professionalism in the medical practice In their introductory remarks, the authors argue that external regulation may decrease the physician moral to be professional. This is true because like in any other profession, the worker is more motivated if he or she is given mush autonomy with regard to their work as opposed to when they are micromanaged. External regulation, for most physicians count as micromanagement and this may hinder a doctor’s will to increase his or her professionalism. Kordkheili, Wild and Strech (2013) argue that medical professionalism is also affected by the social media. In their study, they identified at least 10 positive factors for social media with regard to medical professionalism and 13 negative factors with regard to the same and that the same should reflect in evaluation of professionalism. In such cases where external regulation is used in a way that the doctor feels that he is being micromanaged, the doctor may end up feeling that he or she needs to only meet the minimum professional requirement. Physicians find themselves in a situation where they have to make highly sensitive ethical decision and in cases where the external regulation is used, it is possible that the external regulation standards do not follow the same standards as the ones that doctor may be subscribing to. In such a case, in fear of being evaluated negatively, the doctor will prefer to use the standards that will place him or her in the right side instead of risking his or her career. This is a critical issue and must be addressed in a more detailed manner because external regulation is also necessary. In this case, the need to identify how external regulation can be used without at the same time killing the morale of the physician to apply their best professional conduct is imminent. Working condition as a factor to determine professionalism The authors also highlight that shorter working hours may also negatively affect a physician’s commitment to his or her professional activity and in return affect his or her commitment professionalism. The nature of doctor work requires that some doctors only work in one health institution for just a few hours a day. Such a physician may have to be working in several health institutions concurrently, only working for a short time every day in any one of them. These several institution may be using different, and sometimes conflicting professional ethics standards and this can affect the ability of the doctor to be able to have a standard professional conduct. The article also identifies, as a matter of statement that financial incentives and disincentives can replace personal, moral, and ethical convictions of a doctor. This is very true because financial rewards are a necessary part of motivating the physician not only to work harder but to also apply professional conduct. At the same time, financial incentives can also be used to discourage a physician to be professional in their work. In institutions where money comes first, the doctors may be discouraged to give the patient the right medicine or treatment if it is going to diminish the profitability of the institution. This is not something that has not occurred. For example, in the United States of America where a lot of people depend on private healthcare insurance especially before the advent of the Affordable Healthcare Act, many physicians and even whole healthcare institutions have been accused of receiving financial kickbacks from insurance companies in order to not give certain prescriptions to the patients that would cost the insurance firms more in terms of covering their customers. This is a different factor that has to be identified with regard to assessing a physician’s professionalism. It is necessary to identify that the professional conduct of a doctor can be affected by the external factors such as the policies of the institution for which the doctor works. The other factor that the authors have clearly identified is the fact that the use of multisource feedback which they argue should not be considered to be synonymous with providing a holistic assessment of professionalism. This was reinforced by the fact that their study identified gaps that have not been addressed and they concluded, through empirical research that there was a gap between the existing tools for evaluating the professionalism of an individual and the various elements of professionalism. As a result, just because a multisource feedback process has been used does not means that the assessment is holistic and that it provides a clear guide as to how professional a candidate is. Mahboob and Evans (2013), say that the issue of professionalism should start at the college level where students should be taught about the elements of medical professionalism. Problems Assessment of an observed clinical encounter The main issue that can be identified in the article is that the authors have not talked about the reliability of some of the assessment tools that they have discussed. While they have discussed that the use of patients’ reviews may in most cases be detrimental to the whole process of assessing a physician for professionalism. They have however not addressed some of the factors that may be linked with the use of observed clinical encounters. The problem with this is that people behave differently when they are being observed. How a doctor may behave while he knows that they are being observed and evaluated is not the same way as when he is not being observed. As a result, there is a necessity to identify how valid the results from such an assessment may be. The doctor can for instance pretend when he or she knows that he is being observed. How further evidence was gained In evaluating this article it was necessary to investigate further in order to identify whether some of the claims that were made in this article were scientifically valid. A closer look at more studies and other articles researched and written by other scholars in peer reviewed journals indicated that the article is accurate in its presentation of the issues. To get more evidence, some search was done in the internet to get articles from peer reviewed articles. Keywords used Financial rewards, effect medical proactive ethics, professionalism External regulation, medical practice, professionalism To make sure that the retuned results from search engines (google was used) only included articles, the phrase journal article was used in order to increase the number of journal articles retuned in the results. To further focus the search for articles written after 2010, the search phrase also included ‘2010’. This gave a number of auricles in both categories and those which were very close to the topic being discussed were used. They showed that indeed, the article was reporting issues that are there in the academic realms. Conclusion It is clear that professionalism is hard to define due to its multi facets. The article has been very accurate in terms of identifying the factors that would be necessary in creating a blueprint for assessing professionalism in medical practice. A lot of factors have been identified as being part of the holistic view of what a complete evaluation of medical professionalism should endear. In this regard, the article is effective in identifying the issues encountered when developing a blueprint for evaluating professionalism. These factors have to be considered when such an evaluation is being carried out. Reference list: Birden, H. et al. (2014). Defining professionalism in medical education: A systematic review. Medical Teacher, 36, 1, , pp. 47-61. Ferguson, J., Wakeling, J., & Bowie, P. (2014). Factors influencing the effectiveness of multisource feedback in improving the professional practice of medical doctors: a systematic review. BMC Medical Education,14, 76 , pp. 14-76. Kordkheili, F., Wild, V. & Strech, D. (2013). The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities. J Med Internet Res, 15, 8 , pp. 184. Mahboob, U. & Evans, P. (2013). Assessment of Professionalism in Integrated Curriculum: The Facultys Perspective. Journal of the College of Physicians and Surgeons Pakistan, 23, 11 , pp. 771-774. Wilkinson, T., Winnie B. Wade, W. & Knock, D. (2009). A Blueprint to Assess Professionalism: Results of a Systematic Review. Academic Medicine, 84, 5 , pp. 551-558. Read More