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the
MEDICAL EDUCATOR
VOL 1, No 6, JULY 1999
Measuring altruism: the making of a doctorby Cindy A. Abole, Public RelationsThe image of a doctor has changed dramatically in past years. Since the advent of managed health care, the public’s eye has been critical, with some viewing today’s doctors as greedy, self-serving and uncaring professionals. Beyond all the stereotypes and name calling, the American public still has high expectations when it comes to their perception of physicians and caregivers. Traits like honesty, integrity and compassion are characteristics which stand out. “People expect to see physicians as altruistic in deeds and thoughts,” said Victor Del Bene, M.D., associate dean for students, College of Medicine. “Altruism, which includes professionalism and dutifulness, is an equally important attribute of one’s physician as knowledge and clinical skillfulness.” But how does a doctor develop altruistic values? Is it something that is acquired or learned? How do physicians compare with people in other professions? In December 1998, the American Medical Association approved a resolution to promote professionalism within medical schools, graduate medical education programs and continuing medical education.
In response, the Association of American Medical Colleges (AAMC) recommends that physicians, regardless of their medical specialty, should possess a common foundation of knowledge, skills, attitudes and values. Although medical school curricula provides an adequate combination of academics and interactive activities to develop patient care skills, measuring and enhancing attitudes and values can be a little tricky. In an effort to revive these professional objectives, the AAMC started the Medical School Objectives Project (MSOP). MUSC is among 23 other U.S. medical schools that provide academic direction and update curricula. Today’s medical schools have the opportunity to adopt learning objectives from MSOP and other sources that would customize, enhance and distinguish their individual programs. Closer to home, many plans for changes in medicine have prompted a “curriculum renewal” within the College of Medicine. This move was the college’s response to AAMC’s recommendation for medical schools and student education programs to improve current educational strategies. Del Bene and Amy Blue, Ph.D., the curriculum design and evaluation coordinator for the College of Medicine, are the college’s MSOP representatives who help define and create goals and objectives for a national model dealing with altruism and professional conduct for physicians. MSOP describes the basic components of altruism, professionalism and dutifulness. Assessment and measurement of these attributes in a medical student can involve a variety of approaches. Faculty and house staff assess students on interpersonal skills and ethics. Patients can contribute by completing a patient perception scale. The current curriculum teaches students to acquire credible clinical skills that define the model physician. The college expects more than skill alone from each medical school graduate. Qualities like knowledge, duty and altruistic values are also important. For medical students, assessment of altruistic values can begin as early as the admissions process. The admissions committee reviews candidates for evidence of altruism and dutifulness by observing behavior, response to guided interviews and analysis of the past record of the individual. Special emphasis is placed on evidence-of-service activities and each candidate’s personal statement. A candidate’s role with volunteerism is examined through individual participation in health care, civic organizations, churches or other college supported activities. Within the medical curriculum, there are many ways to emphasize the values of altruism. Beginning in the first semester, incoming medical students participate in the college’s White Coat Ceremony, an event celebrated since 1995. During the ceremony, students are cloaked with their first white doctor coats, presented with a stethoscope and receive a copy of Reynolds and Stone’s book, “On Doctoring,” a collection of short stories, poems and essays that celebrate the humanity of medicine and the medical profession. A defining moment for the students is the recitation of the doctor’s
oath, an abbreviated version of the traditional Hippocratic Oath. The only
other time this oath is repeated is the day before commencement when medical
graduates assemble again in a formal ceremony attended by peers, family
and other witnesses.
MUSC Gives Back a model of altruismA key university program that has helped reinforce the values of selflessness, commitment and humanity through volunteerism is the MUSC Gives Back Program. It was established in 1993 as a student/community volunteer program, the brain-child of Mark Lyles, M.D., an MUSC graduate.“Volunteering helps affirm why students get into medicine,” said Liz Sheridan, MUSC Gives Back. “It’s not about power or greed. It's about learning to help people who can’t help themselves.” According to Sheridan, medical students consistently represent the majority of individuals who participate as active volunteers. Based upon information from the Gives Back database, there are 160 medical students who have worked 3,453 hours during the 1998-99 academic year. Since its inception in 1993, medical students have contributed more than 22,500 volunteer hours working with Lowcountry agencies and programs. “Promoting volunteering with students has not been the challenge for the program,” Sheridan said. “The real challenge is finding diverse opportunities to meet the needs of students within the community.” In today’s mobile society, opportunities have abounded for students who want to volunteer their time outside the United States. Each year, the number of medical students who participate in medical mission trips has risen. Students often choose to work with established groups or organizations like Global Volunteers. This summer, MUSC students are volunteering their time in various locations including Ecuador, Mexico, Honduras and India. “The experience provided the opportunity to develop altruistic qualities and cultural awareness,” said Carol Savage, Ph.D., assistant dean for student academic programs, College of Medicine, who offers an elective class for students who share an interest in the mission trips. “It expands students' views of the world as it relates to medicine, caring and service.” Mental professionalism an element in resident training by Cindy A. Abole
As America continues to question the values, knowledge, skills and behaviors of new physicians and residents, medical curriculum planners are responding. At MUSC, Graduate Medical Education (GME) is following the lead paved by the Medical School Objectives Project. MUSC is currently reviewing and devising improvements to the resident curriculum for the university’s 500 residents and fellows. “Part of GME’s goal is to teach residents about their role and duty within society,” said Franklin J. Medio, Ph.D., director of the Office of Graduate Medical Education. “We help them understand what society expects of them and focus on the core values of physicians. Residency training hones and guides their behavior as physicians.” Medio is part of the Association of American Medical College’s GME Core Curriculum Project, composed of a 10-member work group which is currently examining and developing resources and a curriculum that will address learning goals, objectives and strategies. Medio is responsible for directing the course of MUSC’s graduate medical core curriculum. During the residency years, physicians shift more of their attention from academics to patient care and professional issues. Consequently, it’s a time when a physician’s values become shaped and defined. Physicians also become challenged by important ethical issues such as ethical standards, patient confidentiality, autonomy and beneficence. Besides providing patient care, resident physicians participate in formal classes and activities designed to enhance their skills, abilities and knowledge. Classroom studies may include more topics like quality improvement, interdisciplinary medicine, the business of managed care, cultural sensitivity, bioethics and alternative medicine. Residents also learn by example. Their relationships with attending
physicians, senior staff and faculty help contribute to their medical values,
and sense of professionalism.
Within MUSC’s teaching environment, residents work in a variety of settings—hospitals, clinics and other outside patient care areas. Residents benefit greatly by observing the quality of care their mentors provide to patients. “Residents look to faculty for guidance about patient care, professional duties and responsibilities and even personal issues,” said Medio. “They really observe and react to what faculty do, which sometimes mean learning both positive and negative traits.” “Teaching others by sharing knowledge, skills and abilities instills confidence,” said Medio. “Residents also assume the role of teacher working with medical students, interns and each other. When a person teaches another, that person learns things twice. First, it reinforces the skill within the teacher; second it helps the student and overall, and that creates a positive environment.” Revisions to include basic science in clinical rotations Revisions to the first two years of the undergraduate curriculum have focused on the incorporation of clinical opportunities into basic science studies. For years three and four, the idea is just the opposite.
In the third year, students will come out of their clinical rotations weekly or biweekly to meet in small groups for interactive in-depth discussions of patient cases. Those cases will revolve around topics chosen to bring out epidemiological principles, basic science issues, as well as the clinical features and management approaches. Each group will likely be precepted by a basic scientist and clinician. “The idea is to take the basic science principles the students have learned in years one and two and reexamine them in the light of what they’ve learned about clinical medicine,” Cope explained. These small-group sessions will be similar to the problem-based learning approach used in the first two years of the Parallel Curriculum. But “because third-year students have taken the required basic sciences courses, the cases will be more advanced,” Privitera said. Borrowing from the past, Privitera, Wiley and Cope hope to reintroduce the Clinical Pathology Conference for fourth-year students. Several years ago, the conference was run by faculty—the new version will be student-driven. Students will be divided into small groups and assigned an unknown case with a number of possible causes. Using their investigative skills, the group must arrive at a diagnosis and present their conclusion and the reasoning behind it to an audience of their peers and College of Medicine faculty members. After their presentation and discussion with audience members, a pathologist will present the actual clinical results of the diagnosis. “Our goal is to draft a more meaningful curriculum for students,” said Wiley, associate professor of medicine. Students' participation in small-group sessions and the Clinical Pathology Conference will facilitate their ability to formulate questions and complete research to uncover the answers—skills that will be essential to them for the remainder of their medical careers. Wiley, Cope, professor of medicine, Privitera, professor of cell and molecular pharmacology and experimental therapeutics, plan to pilot small group sessions for third-year students beginning in January 2000. Their plan must be approved by the Undergraduate Curriculum Committee before being put into action. Continuing Medical Education Conferences:The following conferences are sponsored by MUSC. All conferences will be held in Charleston, S.C. unless noted otherwise. August
25 – 28
September
16 - 17
27 - October 2
30 – Oct. 1
October
29 - 30 Total Hip Arthroplasty Symposium
November
December
3 - 5
For more information on Continuing Medical Education conferences call 876-1925. Graduate Medical Education August
Teaching tips THE BEST WAY to check whether your lecture has been well structured is to have a look at your students’ notes. They can often be an eye opener. The next time you prepare for a LECTURE, consider these points: Learn to keep distracting mannerisms to a minimum;
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University
leaders were instrumental in helping to update and revise the University
Honor Code. SGA president-elect Kelby Hutcheson, left, Honor Council president
Stephen Miller and former SGA president Gretchen Wriston pose with
the signed honor code plaque permanently located in Baruch Auditorium.
Potential
changes developed by Curriculum Coordinating Committee members Philip
Privitera, Ph.D., Kathy Wiley,
M.D., and Dennis Cope, M.D., are designed
to reinforce underlying basic science concepts as students develop their
clinical abilities in third- and fourth- year rotations. Planned modifications
will also encourage the development of life-long learning skills.