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Healthcare issues across the globe: Part II

By Aliye Runyan, MD
AMSA Education and Research Fellow


Professionalism

The conversation surrounding professionalism was fascinating and brought to light a huge unmet need in global medical education. The speaker from the World Federation of Medical Education (WFME) spoke about tenets of professionalism: social accountability of the physician, training to take into account needs of the changing face of medicine, adaptability, training students to understand their global responsibility, and of the need for role models for students. Another speaker pointed out threats to professionalism, including commercialization of medicine, the role of pharmaceutical companies and industry, the deteriorating doctor-patient relationship, and that there are MANY medical schools with no formal curriculum on ethics and professionalism. She described attempts at some formalization, but also brought to light the issue that a lot of professionalism standards are from a Western cultural mindset, and do not take into account vastly different cultural standards from Latin America to India (two of the examples she used). She stressed that professionalism attributes must be integrated throughout medical school curricula and not just taught as a standalone course (as many in the US are).

This brought to mind incredible potential for the IFMSA pre-departure training for clinical exchanges (bilateral, international exchanges of clinical year medical students) to include a (student developed, faculty advised) curriculum on professionalism and medical ethics issues with a culturally sensitive perspective. Perhaps this could even be the beginning of cross-institution and student-faculty collaboration of professionalism courses that may eventually be integrated into formal medical education.

Burnout and self care during training

Burnout of trainees occurs as a result of many factors, including lack of time for self care, growing cynicism towards the system of practice, little time actually spent with patients, and as a result of poor role modeling from higher level physicians who can promote unprofessional behaviors towards patients and colleagues. Furthermore, there are hospital systems in many countries in which residents commonly work 36 hour shifts, a dichotomy from other systems which have recognized the unsafe consequences of such extended work with no sleep. There is the need to raise awareness of work hours reform, as well as proper role modeling for physicians in training.

One speaker noted "new med students go from naive and idealistic [committed to the profession] to knowledgeable and cynical". Development of unhealthy (to the physician) and unprofessional behavior (toward patients and/or colleagues) is a function of context more than education - the hidden curriculum and role modeling. There was a call to action to redefine the definition of excellence for both teachers and students, leading to policy changes in assessment and promotion, which would ideally lead to those most qualified and in line with professional and healthy behavior to move to teaching positions and be promoted within the training process.

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