Abstract and Introduction
Abstract
Background The professionalism of doctors has come in for increasing scrutiny and discussion, within the profession and in society. Professionalism has also become of central interest in undergraduate and postgraduate medical education. There is a great deal of debate about the nature of medical professionalism, how to promote it and what approaches to learning are most effective.
Objective This study aims to identify the role of workplace-based discussion groups in encouraging and supporting the development of professionalism among doctors.
Methods Workplace-based discussion groups including doctors from all non-consultant grades and specialties were established in five hospitals over a 6 month period in 2010–2011. A mixed-methods approach was used to identify the perceived impact of these groups on participants, which included interviewing the group facilitators and education leaders at participating hospitals.
Results Understanding of professionalism at an individual level was improved along with an increased awareness of the collective nature of professionalism in everyday clinical practice. Key to the success of the groups was the creation of a legitimate space to explore professionalism and professional challenges and the use of experienced facilitators who could build trust in the groups.
Conclusions A purely individualistic approach to professionalism does not resonate with contemporary, team-based healthcare. Work-based groups can provide a focus for an approach to professionalism that is mindful of self, the team, the culture and the organisation. This evaluation provides guidance to a range of stakeholders on how to develop educational interventions that foster professionalism, personal and collective, and offers some pointers towards the range of factors that may impact on the outcomes of such activities.
Introduction
Professionalism is a key component of ethical and effective patient care. It is also increasingly under the public and political spotlight. Development as a professional is a central concern of medical educators. There has been much debate in educational and policy literature about what constitutes medical professionalism and professional action in the 21st century, how learning opportunities in this domain should be provided, and how attainment should be measured. However, there have been few tangible solutions to providing effective learning intervention in this domain.
Many of the definitions of professionalism that have emerged over the last three decades have been grounded in 'nostalgic' notions of being professional. These have been accused of "distort (ing) meaningful efforts by medical educators to link medical training with principles and practices of professionalism". Understandably, learners have sometimes been cynical about attempts by educators to 'teach' professionalism.
Emerging contemporary notions of professionalism have begun to focus on individual attributes and on an approach to practice that is acquired and sustained individually and collectively as professional values and behaviours are put to work. When viewed in this way, professionalism is a practical rather than theoretical notion that needs to be worked on daily by individuals, teams and organisations and requiring a collective, institution-wide approach to improve patient care. 'Being professional' therefore involves behaviours, values, actions and interpersonal skills and operates at individual, interpersonal and societal levels. Effective educational interventions to promote professional development are likely to focus on more than one of these aspects and levels. Educational approaches that support 'professionalism in action', nurture professional practices within organisations and promote positive organisational cultures may be a new focus for learning and promoting contemporary professionalism.
An education intervention, undertaken by the London Deanery, introduced hospital-based discussion groups aimed at promoting professionalism, reflective practice and patient-centred care among doctors in training in London. At the time of the intervention, the London Deanery was the organisation overseeing all postgraduate medical education in London. This evaluation aimed to explore the impact of these groups on participants and organisations addressing the following question: What is the perceived impact of work-based discussion groups on the development of professionalism among doctors? This paper describes the evaluation outcomes, and identifies the ways in which such discussion groups might contribute to inculcating professional behaviour within individuals and organisations, and hence improve patient care.