Medical Professionalism Best Practices: Professionalism in the Modern Era Edited by Richard L. Byyny, MD, FACP Douglas S. Paauw, MD, MACP Maxine Papadakis, MD Sheryl Pfeil, MD 2017 Alpha Omega Alpha Honor Medical Society Dedicated to the members of Alpha Omega Alpha Honor Medical Society and the medical profession. Publication of this monograph was funded in-part by a President’s Grant from the Josiah Macy Jr. Foundation. © 2017, Alpha Omega Alpha Honor Medical Society ISBN: - 978-1-5323-6516-4 Table of Contents Dedication........................................................................................................... i Contributors ....................................................................................................... iv Acknowledgments ............................................................................................. vi Preface: Medical Professionalism In the Modern Era Richard L. Byyny, MD, FACP; George E. Thibault, MD ............................. ix Chapter 1 Introduction Richard L. Byyny, MD, FACP .......................................................................... 1 Chapter 2 Constructs of Professionalism David M. Irby, MDiv, PhD ................................................................................ 9 Chapter 3 Transforming a Medical Curriculum to Support Professional Identity Formation Sylvia R. Cruess, MD; Richard L. Cruess, MD ............................................ 15 Chapter 4 Generational Differences in the Interpretation of Professionalism Douglas S. Paauw, MD, MACP; Maxine Papadakis, MD; Sheryl Pfeil, MD ................................................................................................. 33 Chapter 5 Medical Professionalism in the New Millennium: A Neo-Oslerian Call to Caring Charles S. Bryan, MD, MACP ......................................................................... 41 Chapter 6 Resistance and Radicalization: Retraining Professionals for the Modern Era Frederic W. Hafferty, PhD; Barret Michalec, PhD; Maria Athina (Tina) Martimianakis, PhD; Jon C. Tilburt, MD ................ 59 Chapter 7 Building an Infrastructure to Support Professionalism in the Modern Era: The Required Elements (People, Process, and Technology) William O. Cooper, MD, MPH; Gerald B. Hickson, MD ............................. 73 ii Chapter 8 Professionalism Education at Drexel University College of Medicine Steven Rosenzweig, MD; Dennis Novack, MD; Pamela Duke, MD ............ 85 Chapter 9 Becoming a Doctor: The Learner and the Learning Environment—A Complex Interaction Holly Humphrey, MD; Dana Levinsen, MPH ................................................ 97 Chapter 10 Professionalism in the 21st Century: Challenges and Opportunities Eve J. Higginbotham, SM, MD .......................................................................... 117 Reflections on Best Practices for Medical Professionalism in the Modern Era Richard L. Byyny, MD, FACP ........................................................................... 129 iii Contributors Charles S. Bryan, MD, MACP (AΩA, University of South Carolina, 1992, Faculty), is the Heyward Gibbes Distinguished Professor Emeritus of Internal Medicine at the University of South Carolina School of Medicine. Contact Dr. Bryan at: 6222 Westshore Road, Columbia, SC 29206-2121; [email protected]. Richard L. Byyny, MD, FACP (AΩA, University of Southern California, 1964), is the Executive Director of Alpha Omega Alpha Honor Medical Society. Contact Dr. Byyny at: Alpha Omega Alpha, 12635 E. Montview Boulevard, Suite 270, Aurora, CO 80045; [email protected]. William O. Cooper, MD, MPH, is the Cornelius Vanderbilt Professor of Pediatrics and Health Policy, and Director of the Vanderbilt Center for Patient and Professional Advocacy. Contact Dr. Cooper at: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, 2135 Blakemore Avenue, Nashville, TN 37212-3505; [email protected]. Richard L. Cruess, MD, is Professor of Orthopedic Surgery and a Core Member of the Centre for Medical Education at McGill University. Contact Dr. Cruess at: [email protected]. Sylvia R. Cruess, MD, is an Endocrinologist, Professor of Medicine, and a Core Member of the Centre for Medical Education at McGill University. Contact Dr. Cruess at: [email protected]. Frederic W. Hafferty, PhD, is Professor of Medical Education, and Associate Director of the Program in Professionalism and Values at the Mayo Clinic. Contact Dr. Hafferty at: 200 First Street SW, Rochester, MN 55901; [email protected]. Gerald B. Hickson, MD, is Professor of Pediatrics, Joseph C. Ross Chair for Medical Education and Administration, and Senior Vice President for Quality, Safety, and Risk Prevention at Vanderbilt University Medical Center. Contact Dr. Hickson at: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, 2135 Blakemore Avenue, Nashville, TN 37212-3505; [email protected]. Eve J. Higginbotham, SM, MD (AΩA, Morehouse School of Medicine, 2008, Faculty), is the Vice Dean for Penn Medicine Office of Inclusion and Diversity; Senior Fellow, Leonard Davis Institute for Health Economics; and Professor of Ophthalmology at the Perelman School of Medicine, University of Pennsylvania. Dr. Higginbotham is the 2017-18 President of the AΩA Board of Directors. Contact Dr. Higginbotham at: University of Pennsylvania, 3400 Civic Center Blvd., Building 421 PCAM South Expansion, 6th Floor, Philadelphia, PA 19104-5162; [email protected]. Holly Humphrey, MD (AΩA, University of Chicago, 1983), is the Ralph W. Gerard Professor in Medicine, and Dean for Medical Education at the University of Chicago Pritzker School of Medicine. Contact Dr. Humphrey iv at: University of Chicago Pritzker School of Medicine, 924 E. 57th Street, BSCL Box 104, Chicago, IL 60637-1455; [email protected]. David M. Irby, MDiv, PhD, is Professor of Medicine at the University of California San Francisco School of Medicine. Contact Dr. Irby at: 533 Parnassus Avenue, San Francisco, CA 94117; [email protected]. Dennis H. Novack, MD (AΩA, Drexel University, 2001), is Professor of Medicine, and Associate Dean of Medical Education at Drexel University College of Medicine. Contact Dr. Novack at: Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129; [email protected]. Douglas S. Paauw, MD, MACP (AΩA, University of Michigan, 1983), is Professor of Medicine, Rathmann Family Foundation Endowed Chair in Patient-centered Clinical Education, and Clerkship Director for the Department of Medicine at the University of Washington School of Medicine. Dr. Paauw is Co-chair of the AΩA Professionalism Committee. Contact Dr. Paauw at: University of Washington School of Medicine, Department of Internal Medicine, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420; [email protected]. Maxine Papadakis, MD (AΩA, University of California, San Francisco, 1993), is Professor Emeritus of Medicine at the University of California, San Francisco School of Medicine. Contact Dr. Papadakis at: University of California, San Francisco School of Medicine, 513 Parnassus Avenue, S-245, San Francisco, CA 94143-0454; [email protected]. Sheryl A. Pfeil, MD (AΩA, Ohio State University, 1984), is Professor of Clinical Internal Medicine, and Medical Director of the Clinical Skills Education and Assessment Center at Ohio State University College of Medicine. She is a member of the Alpha Omega Alpha Board of Directors, and Co-chair of the AΩA Professionalism Committee. Contact Dr. Pfeil at: Ohio State University, Division of Gastroenterology, Hepatology, and Nutrition, 395 West 12th Avenue, Suite 200, Columbus, OH 43210; sheryl. [email protected]. Steven Rosenzweig, MD (AΩA, Drexel University College of Medicine, 2017, Faculty), is Director of the Office of Community Experience, and Clinical Associate Professor of Emergency Medicine at Drexel University College of Medicine. Contact Dr. Rosenzweig at: Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129; [email protected]. George E. Thibault, MD (AΩA, Harvard Medical School, 1968), is President of the Josiah Macy Jr. Foundation. He is the Daniel D. Federman Professor of Medicine and Medical Education, Emeritus, at Harvard Medical School. Contact Dr. Thibault at: Josiah Macy Jr. Foundation, 44 East 64th Street, New York, NY 10065; [email protected]. v Acknowledgments Thank you to Dr. John A. Benson, Jr. (AΩA, Oregon Health & Science University, 1968), and Dr. Jack Coulehan (AΩA, University of Pittsburgh, 1969), for their help in reviewing and editing the chapters of this mono- graph. Both Drs. Benson and Coulehan are members of The Pharos Editorial Board. A heartfelt thank you to the Josiah Macy Jr. Foundation and Dr. George Thibault for support of the production, publication, and distribution of this monograph with a 2016-17 President’s Grant. vi Preface Medical Professionalism In the Modern Era Richard L. Byyny, MD, FACP George E. Thibault, MD rofessionalism in medicine has been a core value for Alpha Omega Alpha Honor Medical Society (AΩA) since the society’s founding in 1902. Demonstrated professionalism is one of the criteria for elec- Ption to membership in AΩA. Medicine is based on a covenant of trust, a contract we in medicine have with patients and society. Medical professionalism stands on the foundation of trust to create an interlocking structure among physicians, patients, and society that determines medicine’s values